Blood Pressure and Cerebral Blood Flow in Alzheimer Disease
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See related article, pp 139–150
Hypertension is common in patients across the aging mild cognitive impairment (MCI)–Alzheimer disease (AD) spectrum.1 Although some studies suggest potential beneficial cognitive effects of antihypertensive agents in older adults,2 findings have been mixed with regard to treatment of hypertension in MCI and AD.3 Diminished cerebral blood flow and degeneration of cortical regions critical for autoregulatory function (eg, insular gyrus) are both observed as cognitive impairment progresses, potentially raising concerns over hypoperfusion events.4 Some smaller studies have suggested possible deficits in cerebral autoregulation and baroreflex sensitivity in MCI and AD, but other studies have shown no differences between cases and controls.5–8 In this issue of Hypertension, de Heus et al9 report on a detailed study of cerebral autoregulation and baroreflex sensitivity in a relatively large group of older adults who were cognitively normal, had MCI, or were diagnosed with AD. In one of the larger and more comprehensive studies to date, the authors report no deficit in cerebral autoregulation or baroreflex sensitivity in either MCI or AD. These findings have major clinical implications because they could influence treatment decisions in hypertensive patients with cognitive deficits due to AD.
Leveraging baseline data from 2 clinical trials (NILVAD and Neuroexercise trials) and a separately collected set of older controls, de Hues et al designed a case–control study to compare dynamic cerebral blood flow–regulatory mechanisms across the aging MCI–AD spectrum. Mean cerebral blood flow velocity was measured in the middle cerebral …