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Hypertension. 2017 Dec;70(6):1132-1141. doi: 10.1161/HYPERTENSIONAHA.117.09978. Epub 2017 Oct 16.

Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years.

Author information

1
From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.). jenningsjr@upmc.edu.
2
From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.).

Abstract

Hypertension is a presumptive risk factor for premature cognitive decline. However, lowering blood pressure (BP) does not uniformly reverse cognitive decline, suggesting that high BP per se may not cause cognitive decline. We hypothesized that essential hypertension has initial effects on the brain that, over time, manifest as cognitive dysfunction in conjunction with both brain vascular abnormalities and systemic BP elevation. Accordingly, we tested whether neuropsychological function and brain blood flow responses to cognitive challenges among prehypertensive individuals would predict subsequent progression of BP. Midlife adults (n=154; mean age, 49; 45% men) with prehypertensive BP underwent neuropsychological testing and assessment of regional cerebral blood flow (rCBF) response to cognitive challenges. Neuropsychological performance measures were derived for verbal and logical memory (memory), executive function, working memory, mental efficiency, and attention. A pseudo-continuous arterial spin labeling magnetic resonance imaging sequence compared rCBF responses with control and active phases of cognitive challenges. Brain areas previously associated with BP were grouped into composites for frontoparietal, frontostriatal, and insular-subcortical rCBF areas. Multiple regression models tested whether BP after 2 years was predicted by initial BP, initial neuropsychological scores, and initial rCBF responses to cognitive challenge. The neuropsychological composite of working memory (standardized beta, -0.276; se=0.116; P=0.02) and the frontostriatal rCBF response to cognitive challenge (standardized beta, 0.234; se=0.108; P=0.03) significantly predicted follow-up BP. Initial BP failed to significantly predict subsequent cognitive performance or rCBF. Changes in brain function may precede or co-occur with progression of BP toward hypertensive levels in midlife.

KEYWORDS:

MRI, functional; cerebral blood flow; cognition; middle age; prehypertension

PMID:
29038202
PMCID:
PMC5685165
[Available on 2018-12-01]
DOI:
10.1161/HYPERTENSIONAHA.117.09978
[Indexed for MEDLINE]

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