Association of Intensive vs Standard Blood Pressure Control With Cerebral Blood Flow: Secondary Analysis of the SPRINT MIND Randomized Clinical Trial.

Autor:	Dolui S; Department of Radiology, University of Pennsylvania, Philadelphia., Detre JA; Department of Radiology, University of Pennsylvania, Philadelphia.; Department of Neurology, University of Pennsylvania, Philadelphia., Gaussoin SA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina., Herrick JS; Department of Population Health Sciences, University of Utah, Salt Lake City., Wang DJJ; Laboratory of FMRI Technology, Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles.; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles., Tamura MK; Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.; Division of Nephrology, Stanford University School of Medicine, Palo Alto, California., Cho ME; Division of Nephrology and Hypertension, University of Utah, Salt Lake City., Haley WE; Department of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida., Launer LJ; Intramural Research Program, National Institute on Aging, Baltimore, Maryland., Punzi HA; Trinity Hypertension and Metabolic Research Institute, Punzi Medical Center, Carrollton, Texas.; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas., Rastogi A; Department of Medicine, University of California at Los Angeles School of Medicine, Los Angeles., Still CH; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio., Weiner DE; William B. Schwartz, MD, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts., Wright JT Jr; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio., Williamson JD; Sticht Center on Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina., Wright CB; Stroke Branch (intramural)/Division of Clinical Research (extramural), National Institute of Neurological Disorders and Stroke, Bethesda, Maryland., Bryan RN; Department of Diagnostic Medicine; Dell Medical School, University of Texas at Austin, Austin., Bress AP; Department of Population Health Sciences, University of Utah, Salt Lake City., Pajewski NM; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina., Nasrallah IM; Department of Radiology, University of Pennsylvania, Philadelphia.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2022 Apr 01; Vol. 79 (4), pp. 380-389.
DOI:	10.1001/jamaneurol.2022.0074
Abstrakt:	Importance: Antihypertensive treatments benefit cerebrovascular health and cognitive function in patients with hypertension, but it is uncertain whether an intensive blood pressure target leads to potentially harmful cerebral hypoperfusion. Objective: To investigate the association of intensive systolic blood pressure (SBP) control vs standard control with whole-brain cerebral blood flow (CBF). Design, Setting, and Participants: This substudy of the Systolic Blood Pressure Intervention Trial (SPRINT) randomized clinical trial compared the efficacy of 2 different blood pressure-lowering strategies with longitudinal brain magnetic resonance imaging (MRI) including arterial spin labeled perfusion imaging to quantify CBF. A total of 1267 adults 50 years or older with hypertension and increased cardiovascular risk but free of diabetes or dementia were screened for the SPRINT substudy from 6 sites in the US. Randomization began in November 2010 with final follow-up MRI in July 2016. Analyses were performed from September 2020 through December 2021. Interventions: Study participants with baseline CBF measures were randomized to an intensive SBP target less than 120 mm Hg or standard SBP target less than 140 mm Hg. Main Outcomes and Measures: The primary outcome was change in whole-brain CBF from baseline. Secondary outcomes were change in gray matter, white matter, and periventricular white matter CBF. Results: Among 547 participants with CBF measured at baseline, the mean (SD) age was 67.5 (8.1) years and 219 (40.0%) were women; 315 completed follow-up MRI at a median (IQR) of 4.0 (3.7-4.1) years after randomization. Mean whole-brain CBF increased from 38.90 to 40.36 (difference, 1.46 [95% CI, 0.08-2.83]) mL/100 g/min in the intensive treatment group, with no mean increase in the standard treatment group (37.96 to 37.12; difference, -0.84 [95% CI, -2.30 to 0.61] mL/100 g/min; between-group difference, 2.30 [95% CI, 0.30-4.30; P = .02]). Gray, white, and periventricular white matter CBF showed similar changes. The association of intensive vs standard treatment with CBF was generally similar across subgroups defined by age, sex, race, chronic kidney disease, SBP, orthostatic hypotension, and frailty, with the exception of an indication of larger mean increases in CBF associated with intensive treatment among participants with a history of cardiovascular disease (interaction P = .05). Conclusions and Relevance: Intensive vs standard antihypertensive treatment was associated with increased, rather than decreased, cerebral perfusion, most notably in participants with a history of cardiovascular disease. Trial Registration: ClinicalTrials.gov Identifier: NCT01206062.
Databáze:	MEDLINE
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