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Aggressive Blood Pressure Treatment May Improve Brain Function and Reduce Heart Risks in the Elderly

CardioSmart News

Tight blood pressure control may improve outcomes for elderly adults, based on a study linking aggressive hypertension treatment to preserved brain function and reduced risk of heart events. Findings were presented at the American College of Cardiology’s 68th Annual Scientific Session and highlight the importance of blood pressure control, particularly in older adults.

High blood pressure, also known as hypertension, occurs when the force of blood against the artery walls is too high. It affects an estimated 103 million Americans and increases risk for heart disease and life-threatening heart events.

Unfortunately, risk for high blood pressure increases with age, making it especially common in older adults. Aggressive treatment could improve outcomes in this vulnerable population, based on the latest findings.

Known as the INFINITY trial, this study compared standard vs. aggressive blood pressure treatment in elderly adults. It included 199 participants who took blood pressure medicine for a total of three years while researchers tracked key outcomes like brain function and heart risks.

Participants were 81 years old on average at the start of the study and all had high blood pressure, despite many of them taking antihypertensive medications.

To qualify for the study, participants had a minimum systolic blood pressure reading of anywhere from 140 to 170 mmHg, depending on various factors. Systolic blood pressure is the top number in a blood pressure reading, which measures the pressure in the blood vessels when the heart beats.

Through the trial, half of participants had a systolic blood pressure target of 130 mmHg, while the other half had a systolic blood pressure goal of 145 mmHg. Participants worked closely with providers to achieve target blood pressure control. Over the three-year period, participants wore 24-hour blood pressure monitors to track their blood pressure at home.

After three years, imaging showed that participants in the more aggressive treatment group had fewer brain lesions than those in the less aggressive treatment group. They also had significantly fewer heart events, with 4% of non-fatal heart events in the aggressive treatment group vs. 17% in the standard group.

According to authors, brain lesions represent damaged nerve cells and are often associated with slower reflexes, problems with mobility and more signs of cognitive decline. In this study, the difference in brain lesions did not translate to improvements in mobility and brain function. However, researchers said it is likely that three years was too short a time to see such benefits.

Still, experts are encouraged by the improvements associated with tighter blood pressure control in elderly adults.

“I think it’s an important clinical finding, and a very hopeful one for elderly people who have vascular disease of the brain and hypertension,” said William B. White, MD, professor of medicine at the University of Connecticut School of Medicine’s Calhoun Cardiology Center and one of the study’s principal investigators. “With the intensive 24-hour blood pressure treatment we reduced the accrual of this brain damage by 40 percent in a period of just three years. That is highly clinically significant, and I think over a longer time period intensive reduction of the ambulatory blood pressure will have a substantial impact on function in older persons, as well.”

Authors note that their study was limited by the small size and relatively short time period. However, further research could have a meaningful impact on outcomes in older adults.

“The average 80-year-old without a major illness such as cancer or heart failure can expect to live about 13 more years, and if you cut back the accrual of vascular damage over the course of that timeframe it could substantially improve a person’s quality of life,” White said. “In addition, this benefit would likely be amplified in people with more severe or longer-duration hypertension.”

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