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What’s the Best Blood Pressure Goal If You Have Hypertension?

Not bad

I’m not formally questioning the guidelines of established authoritative bodies, but just maybe they’re too high. The 2017 guideline from the American College of Cardiology recommended a treatment goal of under 130/80. Reduction of cognitive impairment is only one of many considerations in setting a treatment goal.

Aiming for systolic blood pressure of 120 or less (instead of 140) may reduce the risk of age-related brain impairment. A recent study suggests the mechanism is better brain blood flow.

Ischemia means poor or no blood flow.

Small vessel ischemic disease (SVID in the brain) is something I see so often in 70-year-olds that I usually ignore it. Mind you, I’m a hospitalist and usually looking for acute major strokes, brain tumors, and bleeding on CT scans. SVID is a chronic disease and it’s often difficult to say how long a specific lesion has been present and whether it’s causing symptoms. Ischemia in the brain is linked to impaired cognitive functioning and dementia. On the other hand, some brain ischemic lesions don’t seem to cause any detectable impairment.

From JAMA Network:

Question:  Is intensive blood pressure treatment associated with less progression of small vessel ischemic disease, as reflected by cerebral white matter lesion volume?

Findings:  In this substudy of a randomized clinical trial of 449 hypertensive patients with longitudinal brain magnetic resonance imaging, intensive blood pressure management to a target of less than 120 mm Hg, vs less than 140 mm Hg, was associated with a smaller increase in white matter lesion volume (0.92 cm3 vs 1.45 cm3).

Meaning:  More intensive blood pressure management was associated with less progression of cerebral small vessel ischemic disease, although the difference was small.

Source: Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions | Dementia and Cognitive Impairment | JAMA | JAMA Network

Steve Parker, M.D.

PS: The Mediterranean diet also reduces dementia and cognitive impairment.

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