Hypertension Linked to White Matter Damage
Back in 2010, the National Institutes of Health launched the systolic blood pressure intervention trial (SPRINT). This major research project included more than 9,000 people aged 50 or over at high risk of cardiovascular disease. A large team of scientists compared drug interventions that lowered blood pressure readings down to the standard target of 140, or further down to 120. The latter was achieved by prescribing additional hypertension-lowering drugs. After a little more than three years, researchers discovered that patients more intensively treated with a double drug intervention had a significantly lower rate of heart attack, heart failure, stroke and death from any cause compared to the modestly treated group.1 There was little point in continuing with the trial when the benefits of the lower target became obvious. Now. . .I would not take a medication to drive my blood pressure down – more about this later. First let’s consider what the scientists found when they looked at the brains of these individuals. In a follow-up study called SPRINT MIND, scientists examined the effects of these blood-pressure-lowering treatments on the white matter of a subgroup of 449 study participants. White matter, which makes up a large portion of the brain, is composed of billions of nerve fibers - axons - that connect brain cells to each other. Axons are covered with myelin, a white fatty sheath that protects them and speeds the flow of electrical signals. Damage to the white matter can occur for a variety of reasons such as leaky blood vessels (bleeding), mini strokes, thinning of the myelin and more, all of which uncontrolled hypertension can cause. In fact, previous studies demonstrated people with high blood pressure have more build-up of white matter lesions and a higher risk of cognitive decline and dementia. So, it’s really no surprise that the researchers found the more blood pressure control, the better.Intensive Control is Far More Effective
The scientists reported that intensive control, or a regimen of two blood-pressure-lowering drugs, was 57 percent more effective at slowing the accumulation of white matter lesions compared to standard treatment of one blood-pressure-lowering drug.2 The researchers published their work in JAMA in August. A member of the research team, Dr. LenorLauner, commented: "Both the brain scans and the cognitive tests reinforce the potential benefits that intensive blood pressure management may have on the brain. We hope that these findings will become the foundation for future studies on how to protect the brain throughout a person’s life." Dr. Walter Koroshetz, of the US National Institute of Neurological Disorders and Stroke, added, "These initial results support a growing body of evidence suggesting that controlling blood pressure may not only reduce the risk of stroke and heart disease but also of age-related cognitive loss."3 However, it was not all good news.Loss of Brain Volume
Interestingly, the patients who underwent the intensive, two-drug regimen to lower blood pressure lost 12.1 percent more total brain volume than those folks who underwent standard, one-drug treatment. The researchers described this loss as small, with unclear clinical significance. I don’t agree. It’s been known for some years that people with mild cognitive impairment have some brain atrophy. Researchers from Oregon Health & Science University even put forward the idea that brain volume is so important to memory function that the rate of brain volume loss may predict whether a patient will develop dementia even before any signs of the disease.4 More research is clearly needed here before I’d feel comfortable endorsing a dual-drug blood pressure lowering regimen. In fact, I would not take ANY blood pressure drug except as a last resort, when lifestyle changes have failed. It seems with the white matter gains, you’re suffering brain volume loss. I’m curious if the reported gains and losses would also occur with natural blood-pressure-lowering therapy. I sure doubt it. A natural approach to reducing blood pressure should include a healthy diet, supplements, meditation and exercise. Obesity is strongly correlated with hypertension, so getting the pounds off is essential. One thing’s for sure, natural therapy would certainly help you avoid the side effects patients experienced during the SPRINT study. And the side effects are nasty. Patients tend not to comply with their doctor’s orders to take these drugs because they’re so unpleasant. Needless to say, the side effects are even worse if you take two blood pressure drugs. SPRINT researchers reported that intensively treated patients, those on the dual-drug regimen in the study, suffered more side effects than those taking standard, one drug therapy. For example, they suffered from more instances of low blood pressure, temporary loss of consciousness caused by a fall in blood pressure, electrolyte abnormalities, and acute kidney injury or acute renal failure.5 On top of this, in an earlier report from SPRINT MIND published in January, the scientists concluded: "Among adults with hypertension, intensive blood pressure control did not significantly reduce the risk of probable dementia."6 It's important to remember that all the SPRINT participants were at high risk of heart disease, and therefore the findings cannot be extrapolated to people who are not at the same level of risk. Regardless, despite the conflicting results in determining blood pressure’s true effect on memory and cognition during this early stage of research, it’s safe to say that controlling your blood pressure is critical to living a long healthy life. If you’re suffering from higher than normal blood pressure, I’d personally recommend using a natural approach to lower your blood pressure first, and then, only if necessary, adding a drug regimen.- https://www.ncbi.nlm.nih.gov/pubmed/26551272
- https://jamanetwork.com/journals/jama/article-abstract/2747671
- https://www.ninds.nih.gov/News-Events/News-and-Press-Releases/Press-Releases/Intensive-blood-pressure-control-may-slow-age
- https://www.eurekalert.org/pub_releases/2004-04/ohs-osr042804.php
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089929/
- https://jamanetwork.com/journals/jama/fullarticle/2723256?widget=personalizedcontent&previousarticle=2747671
