A substudy of the randomized clinical trial compared intensive vs standard systolic blood pressure (SBP) control revealed that the intensive BP treatment was associated with increased, rather than decreased, cerebral perfusion. The substudy included 547 participants (mean age 67.5 years, 40.0% women) with whole-brain cerebral blood flow (CBF) measured at baseline from November 2010; 315 completed follow-up longitudinal brain magnetic resonance imaging including arterial spin labeled perfusion imaging to quantify CBF at a median of 4.0 years after randomization. Mean whole-brain CBF increased from 38.90 to 40.36 mL/100 g/min in the intensive target SBP<120 mm Hg, with no mean increase in the standard target SBP<140 mm Hg (37.96 to 37.12 mL/100 g/min). Gray, white, and periventricular white matter CBF showed similar changes. The association of intensive vs standard treatment with CBF was generally similar across subgroups defined by age, sex, race, chronic kidney disease, SBP, orthostatic hypotension, and frailty, except for an indication of larger mean increases in CBF associated with intensive treatment among participants with a history of cardiovascular disease. Source: https://jamanetwork.com/
