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Intensive BP lowering does not impact cerebral perfusion

Intensive BP lowering did not lower the rate of cerebral perfusion in severe small vessel disease, according to findings recently published in JAMA Neurology.

“Whether intensive BP lowering may be associated with worse outcome in patients with severe [small vessel disease] and confluent [white matter hyperintensities], which is the group in whom severely reduced [cerebral blood flow] and autoregulation have been reported, remains uncertain,” Iain D. Croall, PhD, of the Stroke Research Group at the University of Cambridge, U.K., and colleagues wrote.

Researchers analyzed data from 70 patients (mean age, 69.3 years) with hypertension and symptomatic lacunar infarct and confluent white matter hyperintensities that were authenticated by MRI. Participants were randomly grouped in a 1:1 ratio to have their medication changed to reach intensive (systolic, less than 125 mm Hg) BP or standard (systolic, 130-140 mm Hg) BP levels. Cerebral perfusion was measured at baseline and again in 62 patients after 3 months.

Croall and colleagues found that among all participants, changes in cerebral perfusion and were the same, with a mean change of 0.7 mL/min/100 g in the intensive group vs. –0.5 mL/min/100 g in the standard group. In addition, no changes were seen in the number of adverse events or when white or gray matter was analyzed or was limited to those who reached the intended BP. The mean systolic BP lowered by 27 mm Hg to a mean of 126 mm Hg in the intensive group and 8 mm Hg to a mean of 141 mm Hg in the standard group.

Researchers wrote that their findings support those previously discovered in patients with a MRI-authenticated lacunar stroke. However, Croall and colleagues added that these new findings do not match results found earlier in patients with high BP who did not have small vessel disease or stroke, which indicated intensive treatment made cerebral blood flow higher by resetting the cerebral autoregulatory curve.

“This may be due to patients with [small vessel disease] having more severe cerebrovascular disease than the elderly participants with hypertension included in that study, meaning that a potential increase either may not be possible because of the extent of their preexisting damage or may take longer to achieve,” Croall and colleagues wrote. “The PRESERVE study will investigate this last point when the 2-year study is completed.” – by Janel Miller

Disclosure: Croall reports no relevant financial disclosures. Please see the study for all other authors’ financial disclosures.