Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial
Year: 2023
Type: article
Abstract: BACKGROUND AND PURPOSE: The Systolic Blood Pressure Intervention (SPRINT) randomized trial demonstrated that intensive blood pressure management resulted in slower progression of cerebral white matter hyperintensities, compared with standard therapy. We assessed longitudinal changes in brain functional connectivity to determine whether intensive treatment results in less decline in functional connectivity and how changes in brain functional connectivity relate to changes in brain structure. MATERIALS AND METHODS: Five hundred forty-eight participants completed longitudinal brain MR imaging, including resting-state fMRI, during a median follow-up of 3.84 years. Functional brain networks were identified using independent component analysis, and a mean connectivity score was calculated for each network. Longitudinal changes in mean connectivity score were compared between treatment groups using a 2-sample t test, followed by a voxelwise t test. In the full cohort, adjusted linear regression analysis was performed between changes in the mean connectivity score and changes in structural MR imaging metrics. RESULTS: Four hundred six participants had longitudinal imaging that passed quality control. The auditory-salience-language network demonstrated a significantly larger decline in the mean connectivity score in the standard treatment group relative to the intensive treatment group (P = .014), with regions of significant difference between treatment groups in the cingulate and right temporal/insular regions. There was no treatment group difference in other networks. Longitudinal changes in mean connectivity score of the default mode network but not the auditory-salience-language network demonstrated a significant correlation with longitudinal changes in white matter hyperintensities (P = .013). CONCLUSIONS: Intensive treatment was associated with preservation of functional connectivity of the auditory-salience-language network, while mean network connectivity in other networks was not significantly different between intensive and standard therapy. A longitudinal increase in the white matter hyperintensity burden is associated with a decline in mean connectivity of the default mode network.
DOI: 10.3174/ajnr.a7852
Institutions: Cleveland Clinic, University of Pennsylvania, Stanford University, The University of Texas at San Antonio, Mayo Clinic in Florida, National Institutes of Health, National Institute of Neurological Disorders and Stroke, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, Case Western Reserve University, University of Alabama, University of Alabama at Birmingham, UAB Medicine, Wake Forest University Health Sciences, Wake Forest University, University of California, Los Angeles, University of California San Diego
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: hybrid
Funders: U.S. Department of Veterans Affairs, Radiological Society of North America, National Institutes of Health, Takeda Pharmaceuticals International, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke
Awards: G1304405445, G1425514332, G2301334622, G2573152475, G2866321202, G3042542605, G3491114942, G397302370, G4018866504, G4245472998, G5068655555, G5185313375, G5256763093, G5497268829, MIND the Kidneys, G5831220822, G5971433106, G6268252507, G6330340713, G6948654770, G709749280, G8450174239, G8624175963, G8723760441, G8985239187
OpenAlex ID: W4367176885