Lower blood pressure, longer life
UConn Health Center researchers aim to lessen functional decline in the elderly
Published: Sunday, February 17, 2013
Updated: Monday, February 18, 2013 23:02
UConn Health Center physicians are looking at lower blood pressure as a way to slow functional decline in the elderly.
The UCHC study, called the INFINITY trial, examines the impact of guiding hypertension therapy through ambulatory blood pressure monitoring on accumulation of hypertension and brain function over a 3-year period. Hypertension is known to be associated with vascular disease of the brain, heart and kidney, particularly in older people, limiting their cognitive function and physical mobility. The researchers believe maintaining a constant healthy blood pressure could slow these effects.
Professor of Medicine and Chief of the Hypertension and Clinical Pharmacology Division of the Department of Medicine in the Calhoun Cardiology Center at UConn, Dr. William B. White noted that after checking for other factors such as high cholesterol or a history of smoking, high blood pressure remains the major risk factor that causes too much white matter in the brain.
“The INFINITY study is a follow-up to what we’ve learned from previous research,” White said. “We’re not just observing anymore. Now we’re working on prevention methods.”
The trial consists of three types of blood pressure monitoring: typical doctor’s office, self-measurement at home and the 24-hour ambulatory type. The doctors do a standard set of blood pressures on participants like the kind you receive at a regular check-up. They also have participants perform at-home blood pressures, where patients measure their own blood pressure for a week using a digital device. The third type of testing, ambulatory blood pressure monitoring (ABPM), is round-the-clock monitoring of blood pressure levels.
Leslie Wolfson M.D., professor and chair of the Department of Neurology, said that the blood pressure taken by a doctor may be a poor reflection because it is one sample taken over the course of an entire day. ABPM is taken every 15 minutes during the day and every half hour at night over a 24-hour period. Greater control over testing blood pressure is allowing the doctors to study how blood pressure is affecting hypertension in the brain.
A study White and Wolfson published in Circulation: Journal of the American Heart Association showed that the 24 hour blood pressure monitoring can best predict the headway of cognitive function decline in the elderly with white matter brain hyperintensities.
The study is recruiting participants over 75 years of age with a history of hypertension because too much white brain matter due to high blood pressure is much more common in this age group.
“This study is about improving people’s quality of life. The things that our older patients are most worried about in this point of their lives are losing their mental capacity or mobility,” White said. The researchers want to help the elderly maintain their independence for as long as possible.
In a controlled setting, such as a clinical study, it is easy to monitor blood pressure around the clock. However, there are practicality issues that need to be worked out if patients are going to be able to be responsible for their own health once they leave the doctor’s office. While at-home blood pressure tests are not especially expensive, the accuracy of them still needs to be determined by the researchers.
This trial began in March 2012 and will continue to recruit patients until 2014. According to Wolfson, past research has shown that lower blood pressure is related to less brain damage and thus better functioning. By the end of the study, researchers aim to be able to decrease the damage to the brain and lessen functional decline in older people.