Antihypertensive therapy in the elderly: Effects on blood pressure and cerebral blood flow

Ram, Chirag; Meese, Roderick B.; Kaplan, Norman M.; Devous, Michael D.; Bonte, Frederick J.; Forland, Steven C.; Cutler, Ralph E.

doi:10.1016/0002-9343(87)90145-8

Cited by 29 publications

(12 citation statements)

References 16 publications

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“…Furthermore, SBP has been positively correlated with white matter CBF in the posterior and anterior brain regions of Alzheimer's patients [25]. On the other hand, pharmacological studies with older hypertensive subjects have shown that SBP reductions do not necessarily mirror concomitant reductions in CBF [22,27]. Perhaps the two groups in our study had differences in cerebral autoregulation, but we cannot test this hypothesis.…”

Section: Discussionmentioning

confidence: 66%

Intolerance to initial orthostasis relates to systolic BP changes in elders

et al. 2009

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Section: Discussionmentioning

confidence: 66%

Intolerance to initial orthostasis relates to systolic BP changes in elders

et al. 2009

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“…[7][8][9][10][11][12][13] However, the effects of these medications on cerebral blood flow during orthostatic stress have not been established, particularly in elderly patients with systolic hypertension.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive Therapy Increases Cerebral Blood Flow and Carotid Distensibility in Hypertensive Elderly Subjects

Lipsitz

Gagnon²,

Vyas³

et al. 2005

Hypertension

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Abstract-Many physicians are reluctant to lower blood pressure to recommended levels in elderly hypertensive patients because of concern about producing cerebral hypoperfusion. Because hypertension is associated with potentially reversible structural and functional alterations in the cerebral circulation that may improve with treatment, we investigated whether long-term pharmacological reduction of systolic blood pressure will improve, rather than worsen, cerebral blood flow and its regulation. Three groups of elderly subjects 65 years of age or older were studied prospectively: normotensive subjects (Nϭ19), treated hypertensive subjects with systolic pressure Ͻ140 mm Hg (Nϭ18), and uncontrolled hypertensive subjects with systolic pressure Ͼ160 mm Hg at entry into the study (Nϭ14).We measured beat-to-beat blood flow velocity in the middle cerebral artery (transcranial Doppler ultrasonography), finger arterial pressure (photoplethysmography), and pulsatile distensibility of the carotid artery (duplex Doppler ultrasonography) at baseline and after 6 months of observation or antihypertensive therapy. After baseline hemodynamic measurements, uncontrolled hypertensive subjects underwent aggressive treatment with lisinopril with or without hydroclorothiazide or, if not tolerated, nifedipine or an angiotensin receptor blocker to bring their systolic pressure Ͻ140 mm Hg for 6 months. The other 2 groups were observed for 6 months. After 6 months of successful treatment, uncontrolled hypertensive subjects had significant increases in cerebral blood flow velocity and carotid distensibility that was not seen in the other groups. Treatment reduced cerebrovascular resistance and did not impair cerebral autoregulation. Therefore, judicious long-term treatment of systolic hypertension in otherwise healthy elderly subjects does not cause cerebral hypoperfusion. Key Words: aging Ⅲ angiotensin-converting enzyme inhibitor Ⅲ brain Ⅲ hemodynamics Ⅲ ultrasonography A lthough the treatment of systolic hypertension has been shown in prospective randomized controlled trials to reduce cardiovascular morbidity and mortality in subjects up to age 80, many physicians are reluctant to lower systolic blood pressure (BP) to the recommended level of 140 mm Hg or lower in elderly patients, because of concern that aggressive treatment may cause cerebral hypoperfusion and associated syncope, falls, or cognitive dysfunction. 1,2 Because hypertension is associated with potentially reversible structural and functional changes in the cerebral circulation, we hypothesized that long-term BP reduction would improve, rather than worsen, cerebral blood flow and its regulation. Therefore, we conducted the current study to determine the effects of systolic BP reduction over 6 months on cerebral perfusion in elderly hypertensive patients. We also examined structural and functional changes in the cerebral vasculature potentially affected by BP-lowering, including carotid distensibility and cerebral autoregulation. Methods DesignThe study was a prospective 3-gro...

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“…2 Such treatmentinduced reversal of the cerebrovascular dysfunction associated with hypertension may have a beneficial effect on brain function. 3 Recently, a case has been made for a specific effect of blockade of the renin-angiotensin system (RAS).…”

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confidence: 99%