In other words, and in clinical practice, aiming for a systolic pressure below 120 mm Hg is more effective than a goal of 140 mm Hg in achieving or maintaining good “perivascular” brain health. The principle is always to allow the brain to properly eliminate metabolic by-products which, when they accumulate, can contribute to the development of dementia.
Controlling your blood pressure is optimizing your brain health
The study conducted by MRI of several hundred patients participating in the SPRINT-MIND trial, confirms that participants who received more intensive treatment for hypertension, show a positive and progressive change in the brain structures involved in this “cleaning” mechanism of the brain. These areas involved tend to enlarge as people age or have more cardiovascular risk factors, the authors note.
The analysis of cerebral MRI of 658 participants, aged on average 67 years, all suffering from hypertension but free of diagnosis of diabetes, dementia or history of stroke reveals, following a follow-up period of 4 years, in 243 participants in the intensive treatment group (systolic blood pressure goal of 120 mm Hg) and 199 people in the standard treatment group (systolic blood pressure goal of 140 mm Hg) that:
- on inclusion, the volume of the perivascular spaces is similar in the participants of the 2 groups;
- following 4 years of treatment for arterial hypertension, the volume of the perivascular spaces decreased significantly in the intensive treatment group but did not change in the standard treatment group;
- intensive blood pressure control may therefore help to reverse the effects of hypertension on the perivascular spaces.
“If the brain cannot properly eliminate toxins and metabolic by-products, they accumulate and promote the development of dementia,” summarizes one of the lead authors, Dr. Kyle Kern, expert stroke researcher. to NINDS: “Some research has even suggested that the pulsations of cerebral arteries with each heartbeat help drive the clearance of these toxic brain byproducts into the perivascular spaces. In addition, it is well known that hypertension stiffens the arteries in the long term, impairing function and the ability to eliminate toxins, resulting in widening of the perivascular spaces.
Previous research has confirmed that effective blood pressure control is important for brain health. The results of our analysis thus confirm that intensive blood pressure control can be beneficial by reducing damage to the brain’s toxin and by-product elimination pathway”.
While the study is unclear whether the change in perivascular spaces directly improves thinking ability
or if it is only a by-product or consequence of the treatment of high blood pressure, with no causal relationship to cognition or cognitive decline, the next step is precisely to clarify the relationship between perivascular health and cognition.
However, these data strongly suggest that it may be possible to reduce the size of the perivascular space by intensively lowering systolic blood pressure,
which would allow for better elimination of brain toxins and metabolic by-products and a better chance of maintaining brain health.
