Brain function, cognition, and the blood pressure response to pharmacological treatment.
To extend evidence suggesting that essential hypertension influences neuropsychological performance and that brain function before treatment is related to the success of pharmacological lowering of blood pressure (BP).



A voxel-based examination of the whole brain was conducted among 43 hypertensive patients treated for 1 year with assessment pre and post treatment, using positron emission tomography and neuropsychological testing.



Neuropsychological performance improved over the year of treatment but was unrelated to change in regional cerebral blood flow (rCBF). Neither mean resting rCBF nor responsivity to a working memory task changed significantly with treatment. However, patients with greater lowering of systolic BP during treatment showed increased rCBF responsivity to a working memory task in medial and orbital frontal areas and decreased rCBF responsivity in mid frontal, parietal, thalamus, and pons (as well as lower thalamic rCBF pretreatment). Improved working memory performance over the treatment period was related to decreased responsivity in medial frontal, medullary, and parietal areas. Patients showing greater lowering of BP with treatment seemed to reduce excitatory and enhance inhibitory coupling between memory processing and BP more than those with less treatment success.



Degree of treatment success for both BP and cognitive performance among hypertensives is related to differing patterns of rCBF. Overall, the results emphasize the relevance of brain function to the treatment of hypertension.
Jennings
J Richard
JR
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Christie
Israel C
IC
Muldoon
Matthew F
MF
Ryan
Christopher M
CM
Price
Julie C
JC
Meltzer
Carolyn C
CC
D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D003071:Cognition / Q000187:drug effects* / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D017706:Lisinopril / Q000494:pharmacology / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D014055:Tomography, Emission-Computed
D000959:Antihypertensive Agents; D001262:Atenolol; D017706:Lisinopril