Intensive antihypertensive treatment does not lower cerebral blood flow or cause orthostatic hypotension in frail older adults

Ralf W J Weijs; Bente M de Roos; Dick H J Thijssen; Jurgen A H R Claassen

doi:10.1007/s11357-024-01174-4

Intensive antihypertensive treatment does not lower cerebral blood flow or cause orthostatic hypotension in frail older adults

Geroscience. 2024 May 9. doi: 10.1007/s11357-024-01174-4. Online ahead of print.

Authors

Ralf W J Weijs^{1

2}, Bente M de Roos², Dick H J Thijssen^{1

3}, Jurgen A H R Claassen^{4

5}

Affiliations

¹ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
² Department of Geriatric Medicine (696), Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
³ Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
⁴ Department of Geriatric Medicine (696), Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Jurgen.Claassen@radboudumc.nl.
⁵ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. Jurgen.Claassen@radboudumc.nl.

PMID: 38724874
DOI: 10.1007/s11357-024-01174-4

Abstract

This study aimed to examine the effects of intensive antihypertensive treatment (AHT), i.e., systolic blood pressure target ≤ 140 mmHg, on cerebral blood flow, cerebral autoregulation, and orthostatic hypotension, in a representative population of frail older adults. Fourteen frail hypertensive patients (six females; age 80.3 ± 5.2 years; Clinical Frailty Scale 4-7; unattended SBP ≥ 150 mmHg) underwent measurements before and after a median 7-week AHT targeting SBP ≤ 140 mmHg. Transcranial Doppler measurements of middle cerebral artery velocity (MCAv), reflecting changes in cerebral blood flow (CBF), were combined with finger plethysmography recordings of continuous BP. Transfer function analysis assessed cerebral autoregulation (CA). ANCOVA analysed AHT-induced changes in CBF and CA and evaluated non-inferiority of the relative change in CBF (margin: -10%; covariates: pre-AHT values and AHT-induced relative mean BP change). McNemar-tests analysed whether the prevalence of OH and initial OH, assessed by sit/supine-to-stand challenges, increased with AHT. Unattended mean arterial pressure decreased by 15 mmHg following AHT. Ten (71%) participants had good quality TCD assessments. Non-inferiority was confirmed for the relative change in MCAv (95%CI: -2.7, 30.4). CA remained normal following AHT (P > 0.05), and the prevalence of OH and initial OH did not increase (P ≥ 0.655). We found that AHT in frail, older patients does not reduce CBF, impair autoregulation, or increase (initial) OH prevalence. These observations may open doors for more intensive AHT targets upon individualized evaluation and monitoring of hypertensive frail patients.Clinical Trial Registration: This study is registered at ClinicalTrials.gov (NCT05529147; September 1, 2022) and EudraCT (2022-001283-10; June 28, 2022).

Keywords: Brain blood flow; Frailty; Geriatrics; Longevity; Orthostatic intolerance; Primary health care.

Associated data

ClinicalTrials.gov/NCT05529147