Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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.
Geroscience. 2024 Oct;46(5):4635-4646. doi: 10.1007/s11357-024-01174-4. Epub 2024 May 9.
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).
这项研究旨在探讨强化降压治疗（AHT）对血流、脑自动调节和直立性低血压的影响，研究对象为脆弱的老年人群。14 名脆弱的高血压患者（6 名女性；年龄 80.3±5.2 岁；临床虚弱量表 4-7 级；未监测到的收缩压≥150mmHg）在中位 7 周的收缩压目标≤140mmHg 的 AHT 治疗前后进行了测量。经颅多普勒测量大脑中动脉速度（MCAv），反映脑血流（CBF）的变化，同时结合手指容积描记法记录连续血压。传递函数分析评估脑自动调节（CA）。ANCOVA 分析了 AHT 引起的 CBF 和 CA 变化，并评估了 CBF 相对变化的非劣效性（边际：-10%；协变量：AHT 前值和 AHT 引起的相对平均血压变化）。McNemar 检验分析了直立性低血压（OH）的患病率是否随 AHT 而增加，通过坐/卧位到站立位的挑战来评估。AHT 后未监测的平均动脉压下降 15mmHg。10 名（71%）参与者的 TCD 评估质量良好。MCAv 相对变化的非劣效性得到确认（95%CI：-2.7，30.4）。AHT 后 CA 仍保持正常（P＞0.05），OH 和初始 OH 的患病率没有增加（P≥0.655）。我们发现，在脆弱的老年患者中，AHT 不会降低 CBF、损害自动调节或增加（初始）OH 的患病率。这些观察结果可能为更积极的 AHT 目标打开大门，前提是对高血压脆弱患者进行个体化评估和监测。临床试验注册：本研究在 ClinicalTrials.gov（NCT05529147；2022 年 9 月 1 日）和 EudraCT（2022-001283-10；2022 年 6 月 28 日）注册。
