• Researchers from the University of Texas Health Science Center at San Antonio analyzed the impact of intensive versus standard hypertension treatment on brain lesions.
• Utilizing data from a prior study, the scientists found that intensive treatment that keeps blood pressure at a normal range is linked to reduced progression of lesions.
• The researchers looked at data from people at least 50 years older and above.
• With more research and trials, the study findings have the potential to impact treatment plans for people with hypertension to reduce the risk of lesions that can lead to reduced cognitive functioning.

Hypertension affects millions of people and can contribute to poor brain health by causing brain lesions and strokes.

In a new study, led by UT Health San Antonio, researchers show that intensive blood pressure treatment can reduce the progression of white matter lesions in the brain.

The researchers looked at MRI scans of people who stayed under a systolic blood pressure reading below 120 mm Hg versus a systolic reading of 140 mm Hg.

The study is published in JAMA Network Open.

What counts as hypertension?

Hypertension, or high blood pressure, is a medical condition that affects millions of people in the United States. According to the Centers for Disease Control and Prevention, hypertension affects nearly half of adults in the U.S. and was responsible for more than 670,000 deaths in 2020.

High blood pressure can lead to damaged blood vessels and cause various health problems. Some health issues caused by hypertension include heart attacks and strokes.

The American Heart Association describes the following blood pressure levels:

• A normal blood pressure reading should be an upper number (systolic) of less than 120 over a diastolic number (lower) of 80 mm Hg for adults.
• Elevated blood pressure is 120-129 over less than 80.
• Stage 1 hypertension is between 130-139 over 80-89.
• Stage 2 hypertension is at least 140 over 90.
• A hypertension crisis occurs when the systolic number is more than 180 and/or a diastolic number of more than 120.

As cardiologist Dr. Kershaw Patel notes in the Houston Methodist podcast On Health, “when we talk about high blood pressure, it’s important that we realize it affects not just the heart, but also the brain, the kidneys, and other organs in the body.”

Doctors often treat high blood pressure with prescription medications, but people can also make lifestyle changes to try to lower or normalize their blood pressure.

“Blood pressure is typically treated mostly with lifestyle changes and then medications,” commented Dr. Patel. “And it’s really about two-thirds lifestyle and a third medication. We can make meaningful reductions in blood pressure levels just with changing certain lifestyle factors.”

Quitting smoking, reducing alcohol intake, eating a diet low in sodium, exercising, and increasing the intake of fruits and vegetables can help normalize blood pressure.

Getting blood pressure under 120

The standard treatment recommended by the American Academy of Family Physicians (AAFP) for people with hypertension aims to get them to a systolic blood pressure of 140 mm Hg. According to the AAFP, this target reduces the risk of cardiovascular mortality.

The UT Health San Antonio researchers compared the standard treatment target to a more intensive treatment to analyze the impact on white matter lesions (WMLs). The intensive treatment target was designed to get participants to a systolic blood pressure of less than 120 mm Hg.

Using data from the Systolic Blood Pressure Intervention Trial (SPRINT), which followed participants for 4 years, the researchers analyzed information from 458 participants. According to the study authors, the participants were “aged 50 years or older with hypertension and without diabetes or a history of stroke.”

The scientists compared each participant’s treatment with their MRI scans at the beginning and end of their trials. They were looking for the presence of WMLs, which are a type of damage in the white matter of the brain that can cause cognitive decline.

Intensive treatment reduces brain damage

The study results showed that the intensive treatment group had slowed progression in WML volume and slower decreases in fractional anisotropy (FA) compared to the standard treatment group.

The FA finding is significant because it is a “measure of connectivity in the brain.” Some of the brain regions that experienced reduced progression of WMLs include the left anterior corona radiata, right splenium, and right tapetum.

Additionally, the study shows that the intensive blood pressure treatment could preserve myelin structure in some areas which the authors say “ultimately slows the progression of injury patterns associated with dementia.”

“Our study shows that specific areas have greater benefit, representing sensitive regions to track in future trials evaluating small-vessel disease,” says study author Dr. Tanweer Rashid, who works with the Biggs Institute at UT Health San Antonio.

How blood pressure affects white matter

Dr. Arun Manmadhan, a cardiovascular disease specialist at Columbia University Irving Medical Center in New York City, spoke with Medical News Today about the study findings.

“White matter lesions are abnormal areas of damaged tissue in the brain’s white matter. They are typically caused by abnormalities in the small blood vessels that supply the brain with oxygen and nutrients,” Dr. Manmadhan explained.

Dr. Manmadhan elaborated on the study findings in terms of how blood pressure can impact WMLs.

“The current report, which is a sub-study of SPRINT-MIND, looked at the effects of strict blood pressure control on white matter changes in the brain as assessed by MRI. The findings here suggest that strict [blood pressure] control may slow the progression and development of white matter lesions, which are associated with an increased risk of cognitive decline and dementia,” said Dr. Manmadhan.

Overall, Dr. Manmadhan felt the study is a positive addition to the field of hypertension.

“This study adds to the already extensive body of literature that managing blood pressure is very important for not only preventing cardiovascular events but also in maintaining memory and cognition,” he said.

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