PDF(Pubmed)
Abstract：
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).
摘要：
这项研究旨在检查强化降压治疗（AHT）的效果，即，收缩压目标值≤140mmHg，脑血流，大脑自动调节,和直立性低血压,在虚弱的老年人的代表性人群中。14名虚弱的高血压患者（6名女性；年龄80.3±5.2岁；临床虚弱量表4-7；无人看管SBP≥150mmHg）在中位数7周AHT之前和之后进行了测量，目标为SBP≤140mmHg。经颅多普勒测量大脑中动脉速度(MCAv),反映脑血流量（CBF）的变化，结合手指体积描记术记录的连续BP。传递函数分析评估了大脑自动调节（CA）。ANCOVA分析了AHT诱导的CBF和CA的变化，并评估了CBF相对变化的非劣效性（边缘：-10％；协变量：AHT前值和AHT诱导的相对平均BP变化）。McNemar测试分析了OH和初始OH的患病率是否，通过坐/仰卧起坐挑战来评估，随着AHT增加。AHT后，无人看管的平均动脉压降低了15mmHg。10名（71％）参与者的TCD评估质量良好。MCAv的相对变化证实了非劣效性(95CI:-2.7,30.4)。AHT后CA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AHT很脆弱，老年患者不能降低CBF,损害自动调节，或增加（初始）OH患病率。这些观察结果可能会在对高血压虚弱患者进行个性化评估和监测时为更密集的AHT目标打开大门。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。
