title: Aldosterone, cognitive function, and cerebral hemodynamics in hypertension and antihypertensive therapy.
abstract: BACKGROUND
  Animal studies suggest that the renin-angiotensin-aldosterone system is involved in neurocognitive function and the response to antihypertensive therapy. We investigated the impact of circulating aldosterone and renin activity on cognition and cerebral hemodynamics at baseline and after antihypertensive therapy for 1 year.
  
  
  METHODS
  Participants were older adults (n = 47; mean age = 71 years) enrolled in a clinical trial. Routine antihypertensive medications were replaced with the study regimen to achieve a blood pressure <140/90 mm Hg. Executive function, memory, cerebral hemodynamics (blood flow velocity), CO2 vasoreactivity (measured using transcranial Doppler ultrasonography), plasma renin activity, and aldosterone were measured at baseline and at 6 and 12 months after the initiation of treatment.
  
  
  RESULTS
  At baseline, higher levels of circulating aldosterone were associated with lower blood flow velocity (β = -0.02; P = 0.03), lower CO2 vasoreactivity (β = -0.11; P = 0.007), and decreased autoregulation abilities (β = -0.09; P = 0.01). Those with higher levels of aldosterone at baseline demonstrated the greatest improvement in executive function (P = 0.014 for the aldosterone effect) and in CO2 vasoreactivity (P = 0.026 for the aldosterone effect) after 12 months of lowering blood pressure (<140/90 mm Hg). Plasma renin activity was not associated with any of the measures.
  
  
  CONCLUSIONS
  Higher levels of aldosterone may be associated with decreased cerebrovascular function in hypertension. Those with higher aldosterone levels may benefit the most from lowering blood pressure. The role of aldosterone in brain health warrants further investigation in a larger trial.
authors.affiliation: Division of Geriatrics and General Internal Medicine, Department of Medicine, Emory University, Atlanta, Georgia, USA; ihajjar@emory.edu.
authors.forename: Ihab
authors.initials: I
authors.lastname: Hajjar
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA;
authors.forename: Meaghan
authors.initials: M
authors.lastname: Hart
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA;
authors.forename: Wendy
authors.initials: W
authors.lastname: Mack
authors.affiliation: Harvard Medical School, Institute for Aging Research, and Hebrew SeniorLife, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002560:Cerebrovascular Circulation; D003071:Cognition; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D000450:Aldosterone; D012083:Renin
keywords: aldosterone; blood flow velocity hypertension; blood pressure.; cognition; renin; vasoreactivity