Uncontrolled high blood pressure damages the brain's
structure and function as early as young middle-age, and even the brains of
middle-aged people who clinically would not be considered to have hypertension have evidence of silent structural
brain damage, a study led by researchers at UC Davis has found.
The
investigation found accelerated brain aging among hypertensive and
prehypertensive individuals in their 40s, including damage to the structural
integrity of the brain's white matter and the volume of its gray matter,
suggesting that vascular brain injury "develops insidiously over the lifetime
with discernible effects."
The study is the first to demonstrate that
there is structural damage to the brains of adults in young middle age as a
result of high blood pressure, the authors said. Structural damage to the
brain's white matter caused by high blood pressure previously has been
associated with cognitive decline in older individuals.
Published online
in the medical journal The Lancet Neurology, the study will appear in
print in the December 2012 issue. It emphasizes the need for lifelong attention
to vascular risk factors for brain aging, said study senior author Charles
DeCarli, professor of neurology and director of the UC Davis Alzheimer's Disease
Center.
"The message here is really clear: People can influence their
late-life brain health by knowing and treating their blood pressure at a young
age, when you wouldn't necessarily be thinking about it," DeCarli said. "The
people in our study were cognitively normal, so a lack of symptoms doesn't mean
anything."
Normal blood pressure is considered a systolic blood pressure
-- the top number -- below 120 and a diastolic pressure -- the bottom number --
below 80. Prehypertensive blood pressure range is a top number between 120 and
139 and a bottom number between 80 and 89. Blood pressures above 140 over 90 are
considered high.
Elevated blood pressure affects approximately 50
million Americans and is associated with a 62 percent risk of cerebrovascular disease, such as ischemic stroke, and a 49 percent risk of cardiovascular
disease. It is the single-greatest risk factor for mortality in the United
States.
Earlier studies have identified associations between elevated
blood pressure and a heightened risk of brain injury and atrophy leading to
reduced cognitive performance and a greater likelihood of dementia, making hypertension an important,
modifiable risk factor for late-life cognitive decline. There is evidence, the
study says, that lowering blood pressure among people in middle age and in the
young elderly can help prevent late-life cognitive decline and dementia.
Titled "Effects of Systolic Blood Pressure on White Matter Integrity in
Young Adults: From the Framingham Heart Study," the research sought to decipher
the age of onset, extent and nature of the effects of elevated systolic blood
pressure on cognitive decline among participants in the Framingham study, a
longitudinal evaluation begun more than 60 years ago of the cardiovascular
health of the residents of Framingham, Mass., that is now in its third
generation of participants.
The research included 579 Framingham
participants who were, on average, 39 years old when recruited for participation
in the study, which launched in 2009. Their blood pressure was measured as the
average of two physician-recorded blood pressures. The study subjects were
organized into groups with normal blood pressure, those who were prehypertensive
and those with high blood pressure. Whether they were receiving treatment for
high blood pressure and whether they smoked also was noted.
The
meticulously conducted study used magnetic resonance imaging (MRI) to
determine the participants' brain health using a variety of measurements of
white matter injury and gray matter volume. The MRI exams included diffusion
tensor imaging, a particular kind of image that reveals microscopic details of
tissue architecture within the white matter of the brain. The white matter
includes the axons, the biological "wires" of the brain that carry information
from one part of the brain to the other. Measurements from diffusion tensor
imaging, such as fractional anisotropy, take on larger values if the axons are
more intact. White-matter hyperintensities -- white-matter areas that appear
intensely white on another kind of MRI scan -- suggest more severe damage than
fractional anistropy does, and gray matter density also were examined. The
imaging studies then were combined to create a global measurement of brain
health that compared normal and hypertensive subjects.
The results were
that, in hypertensive individuals, fractional anisotropy in the frontal lobes
was reduced by an average of 6.5 percent. The hypertensives also had 9 percent
less gray matter, on average, in their brains' frontal and temporal lobes.
Hypertensive individuals' brains were significantly less healthy than those of
subjects with normal blood pressure. For example, a typical 33-year-old
hypertensive's brain health was similar to that of the typical 40-year-old
normotensive subject. So, for those 33-year-olds, high blood pressure had
prematurely aged the brain by seven or so years.
The authors did not
postulate a mechanism for the damage. However, they noted that high blood
pressure causes arteries to stiffen, thus making the blood flowing to the brain
pulse more strongly. This stresses the blood vessels of the brain, likely making
it more difficult for them to nourish brain tissue such as axons.
"This
work suggests that recently described white matter microstructural damage
associated with high blood pressure in the elderly may be detectable earlier in
the life span, further reinforcing the view that vascular brain injury may
develop insidiously over several decades," said Pauline Maillard, the study's
lead author and a postdoctoral fellow in the UC Davis Department of Neurology.
"These results emphasize the need for early and optimum control of blood
pressure, which is neither routinely achieved nor subject to testing in
randomised controlled clinical trials."
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