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Intensive BP Control in Elderly With HTN May Aid Brain Health

Authors say benefit in functional outcomes might be seen with longer follow-up

MONDAY, Nov. 4, 2019 (HealthDay News) — Intensive lowering of ambulatory blood pressure in older patients with hypertension reduced accumulation of small vessel disease in the white matter of the brain, according to a study published online Oct. 14 in Circulation.

William B. White, M.D., from the University of Connecticut in Farmington, and colleagues randomly assigned 199 patients (mean age, 80.5 years) who had magnetic resonance imaging evidence of white matter hyperintensity lesions to either intensive treatment (24-hour mean systolic blood pressure of ≤130 mm Hg) or standard treatment (≤145 mm Hg) with antihypertensive therapies.

The researchers found that goal blood pressures were achieved after a median treatment period of three to four months. At this time, the mean 24-hour systolic blood pressure was 127.7 mm Hg in the intensive-treatment group and 144.0 mm Hg in the standard-treatment group. There was no difference noted between the treatment groups with respect to changes in gait speed or cognitive outcomes. From baseline, changes in white matter hyperintensity volumes were smaller (0.29 percent) in the intensive-treatment group versus the standard-treatment group (0.48 percent). There were more major adverse cardiovascular events in the standard-treatment group versus the intensive-treatment group (17 versus four patients). The treatment groups were similar with respect to number of falls (with or without injury) as well as syncope.

“After three years, intensive treatment levels of ambulatory blood pressure did not show lessening of mobility or cognitive decline compared with standard treatment levels; however, less accrual of white matter disease was observed in those with intensive treatment,” the authors write.

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