Blood flow in brain improves after antihypertensive therapy

Depositphotos_154224424_s-2019.jpgMedics from Sechenov University ruled out that common antihypertensive medications improved the cerebral blood flow. This effect could help prevent the patients from complications in later life — strokes and dementia.

Arterial hypertension is a major trigger of cardiovascular disease. Although people aged 60 and older are at a higher risk, the prevalence of hypertension among middle-aged and younger adults is also considerable. Individuals aged 20–39 with a high blood pressure have an 8- to 30-fold increased rate of coronary heart disease in later life. Hypertension may cause ‘silent’ brain lesions, such as white matter hyperintensities and silent lacunar strokes, increasing the risk of subsequent stroke, cognitive impairment, and dementia. Despite this, hypertension awareness and control are not common among young adults. A group of scientists from Sechenov University conducted a study where middle-aged patients were given a combination of perindopril arginine and indapamide, well-known antihypertensive drugs, to monitor the changes in the cerebral blood flow. The study has been published in the journal Advances in Therapy.

The connection between blood pressure (BP) and cerebral blood flow (CBF) is not established very well. CBF characterises the blood supply to the brain, and in an adult person, it is estimated to be around 15% of the cardiac output. Too much blood, or hyperaemia, would raise intracranial pressure leading to brain damage, and too little blood, or ischaemia, may cause tissue death. Medics need to control the BP within an acceptable physiological range to prevent negative consequences for the brain via extreme changes in the CBF.

The team from Sechenov decided to evaluate the role of a perindopril arginine/indapamide (Pa/I) single-pill combination (SPC) on CBF in middle-aged patients. According to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the management of arterial hypertension, SPC therapy is the gold standard for most patients.

The study included two groups — healthy volunteers and persons with grade 1–2 hypertension — all aged 40–59 years, males and females, from outpatient cardiology and neurology centres in Moscow. The group of treatment-naïve patients with hypertension contained 22 people with the mean systolic BP/diastolic BP (SBP/DBP) of 146.2/93.1 mmHg, and the control group included 41 healthy people with the mean SBP/DBP of 119.1/76.1 mmHg.

The subjects underwent brain magnetic resonance imaging (MRI) to control the CBF and the effect of the treatment. The arterial spin labelling (ASL) technique was used to calculate the CBF in the frontal lobe cortical plate. The subjects with hypertension received Pa/I SPC (5 mg/1.25 mg) once per day.

Initially, the patients with hypertension had a significantly lower CBF in the cortical plate of both frontal lobes compared to the normotensive controls. At the end of the treatment and observation period, the patients who had been receiving Pa/I SPC showed a considerable increase in the CBF compared to the baseline: in the left frontal lobe, from 36.2 to 47.5 ml/100 g/min, and in the right frontal lobe, from 37.9 to 47.4 ml/100 g/min. These figures (after the treatment) were comparable to the normal levels in healthy subjects.

‘Currently, it is extremely important to identify markers of early brain damage and to develop antihypertensive therapy for the effective control of the condition — especially in middle-aged patients, as it may help prevent them from strokes and dementia’, said Tatiana Ostroumova, Assistant Professor at the Department of Neurology and Neurosurgery (Sechenov University) and the first author of the paper. ‘Using the non-invasive arterial spin labelling, we revealed a decreased perfusion in the frontal lobes in patients with hypertension at an early stage of the disease. These figures differed from those of healthy volunteers. A combination of antihypertensive drugs normalised cerebral perfusion, and it is a good sign that this strategy could improve the quality of life of such patients’.

The study was carried out by Sechenov University (Department of Neurology and Neurosurgery, Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Division of Diagnostic Radiology) and Russian Medical Academy of Continuous Professional Education (Moscow).

Read more:

Ostroumova TM, Ostroumova OD, Parfenov VA, Perepelova EM, Perepelov VA, Kochetkov AI. Effect of Perindopril/Indapamide on Cerebral Blood Flow in Middle-Aged, Treatment-Naïve Patients with Hypertension. Adv Ther (2020).