The medical mantra that "good for the heart is good for the brain" received more support on Wednesday.
Aggressively lowers blood pressure in people at high risk for heart attack and stroke also reduces their likelihood of developing mild cognitive impairment (MCI), a condition that often leads to dementia, a new study found.
"This is the first intervention ever to reduce the risk of MCI," said Jeff Williamson, who led the study and the Alzheimer's Research Center at Wake Forest University, Winston-Salem, North Carolina.
Patients who were treated up to 120 mm Hg to lower their systolic blood pressure, the upper number in a blood pressure measurement, were 19 percent less likely to have mild cognitive impairment than patients with a blood pressure of 140 mm Hg  The research was presented on Wednesday at the annual Alzheimer's Association International Conference in Chicago. The data are considered provisional since they were not published or reviewed, and Williamson said he had seen the last patients only in the last month
But he and several other caregivers said they are already excited by the results.
"That really should have a big impact on how we see in healthcare, and in particular family practice and primary care, what the goal should be for lowering blood pressure," said Sharon Cohen, behavioral neurologist and director of the Toronto Memory Program , Canada's largest Alzheimer's Clinic. Cohen, who was not involved in the new study, said, "It's not good enough to target systolic, we should go deeper."
The study tracked 9,300 people, many of whom were over 75 years old who had kidney disease or otherwise had a high risk of cardiovascular problems. They were divided into two groups, one with a systolic blood pressure of 140 and one of 120. Both groups were asked to change their lifestyle to lower their blood pressure, such as regular exercise, adequate sleep, and a healthy diet
The American Heart Association and the American College of Cardiology issued new guidelines last year stating that patients with a blood pressure of 130/80 should be treated instead of the previous 140/90 standard.
In the new study, those who targeted 140 had an average of two medications, while those who reached 120 received three medications. Both were on medication for an average of three years.
The federally funded study was more diverse than many previous studies with 30 percent of participants identified as African Americans and 10 percent as Hispanics. The study found no difference in results by race, race, or gender, Williamson said.
Designed to look at heart disease, a security committee decided in 2015 that there was no doubt that lowering the blood pressure benefited the hearts of participants stopped the study. Patients went back to their regular doctors and some continued with blood pressure control.
The study looked at these participants a few years later to see if it had an impact on brain function. In addition to the reduced risk of mild cognitive impairment, MRI in a group of participants showed that reducing their blood pressure also lowers the risk of tiny cerebral hemorrhages, said Laurie Ryan, head of the Department of Dementia of Aging at the Department of Neuroscience at the National Institute for Neuroscience Aging, which funded the study together with the National Heart, Lung and Blood Institute.
The study showed an increase in headache and dizziness and a greater susceptibility to dehydration and mineral imbalances in people with the lower blood pressure target, but no falls or serious incidents.
"I was unsure as a scientist, was blood pressure lowering as good for the brain as it was for the heart? That was a really unanswered question," Williamson said.
But the data he has seen so far has been compelling, he said.
"I have changed my personal practice," he said, noting that he ensures his own blood pressure is well controlled, and in his medical practice, "we talk to individuals about increasing their blood pressure in the range of 120-130 to reach."
Harlan Krumholz, a cardiologist and health researcher at Yale University and Yale-New Haven Hospital in Connecticut, said he sees the study more as a beginning of a conversation rather than a hard and fast blood pressure target. It is not realistic, he said, that every patient is willing or able to make lifestyle changes and take medication three times a day to lower his blood pressure.
Some patients, he said, take the posture to help me at all, I'm all in, "while others want more evidence before they agree to more medication.
But the study now gives them another choice He said that in the past, few people would have had the opportunity to lower their blood pressure to 120.
"We really need to get together with patients and do the hard work of trying to understand what's on their minds is best, "said Krumholz.
Read or Share This Story: https://usat.ly/2v2QdyF