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Is This Blood Pressure Ideal for Preventing Dementia?


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Keeping your systolic blood pressure below 120 is good for your heart. New research suggests it also might protect your brain.

A review of MRI brain scans indicates that treating high blood pressure more intensively — by keeping systolic pressure (the first number in a blood pressure reading) at less than 120 rather than below the standard treatment goal of 140 — created a positive change in the structure of the brain’s perivascular spaces.

These spaces play a crucial role in clearing toxins and other metabolic byproducts that are thought to contribute to dementia when they are left to accumulate in the brain. Perivascular spaces tend to get bigger as people age or have more cardiovascular risk factors.

The findings are being presented at the American Stroke Association’s International Stroke Conference 2023 in Dallas.

In a summary of the research, Dr. Kyle Kern, lead author of the study and a clinical research fellow in the intramural stroke branch of the National Institute of Neurological Disorders and Stroke, says:

“Some research has proposed that the pulsations of the cerebral arteries with each heartbeat help to drive the clearance of these toxic brain byproducts in the perivascular spaces. However, high blood pressure over the long term stiffens arteries, impairing function and the ability to clear toxins, resulting in enlargement of perivascular spaces.”

As part of the study, the researchers analyzed scans of 658 participants who were an average age of 67. All participants had high blood pressure.

As the study began, participants in two groups — one with the more intensive blood pressure treatment and one with the standard treatment — had similar volume of perivascular spaces.

However, nearly four years later, those with the more intensive treatment had perivascular spaces that decreased significantly in volume, a positive outcome.

The researchers also found that intensive blood pressure control may actually help reverse the impact of high blood pressure on perivascular spaces. In the summary of the findings, Kern says:

“These results also suggest that perivascular spaces are more dynamic, and further research is needed to determine the relationship between perivascular space change and the progression of white matter hyperintensities.”

The research did not mention diastolic blood pressure (the second number in a reading), but the American Heart Association notes that normal diastolic pressure is less than 80.

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