Cerebrovascular Function, Vascular Risk, and Lifestyle Patterns in Resistant Hypertension

Article type: Research Article

Authors: Smith, Patrick J.^{a; *} | Sherwood, Andrew^a | Hinderliter, Alan L.^b | Mabe, Stephanie^a | Tyson, Crystal^a | Avorgbedor, Forgive^c | Watkins, Lana L.^a | Lin, Pao-Hwa^d | Kraus, William E.^d | Blumenthal, James A.^a

Affiliations: [a] Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA | [b] Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA | [c] School of Nursing, The University of North Carolina at Greensboro, NC, USA | [d] Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA

Correspondence: [*] Correspondence to: Patrick J. Smith, PhD, MPH, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. Tel.: +1 919 681 3006; Fax: +1 919 684 8629; E-mail: [email protected].

Abstract: Background:Impaired cerebrovascular reactivity (CVR) and blunted cerebral hemodynamic recruitment are thought to be important mechanisms linking hypertension to cerebrovascular and cognitive outcomes. Few studies have examined cardiovascular or dietary correlates of CVR among hypertensives. Objective:To delineate associations between cardiometabolic risk, diet, and cerebrovascular functioning among individuals with resistant hypertension from the TRIUMPH trial (n = 140). Methods:CVR was assessed by examining changes in tissue oxygenation (tissue oxygenation index [TOI] and oxygenated hemoglobin [HBO2]) using functional near-infrared spectroscopy (fNIRS) during a breath holding test, a standardized CVR assessment to elicit a hypercapnic response. Participants also underwent fNIRS during three cognitive challenge tasks. Vascular function was assessed by measurement of brachial artery flow-mediated dilation and hyperemic flow response. Cardiometabolic fitness was assessed from peak VO2 on an exercise treadmill test and body mass index. Dietary patterns were quantified using the DASH eating score. Cognitive function was assessed using a 45-minute test battery assessing Executive Function, Processing Speed, and Memory. Results:Greater levels fitness (B = 0.30, p = 0.011), DASH compliance (B = 0.19, p = 0.045), and lower obesity (B = –0.30, p = 0.004), associated with greater changes in TOI, whereas greater flow-mediated dilation (B = 0.19, p = 0.031) and lower stroke risk (B = –0.19, p = 0.049) associated with greater HBO2. Similar associations were found for cerebral hemodynamic recruitment, and associations between CVR and cognition were moderated by duration of hypertension. Conclusion:Impaired CVR elevated cardiometabolic risk, obesity, vascular function, and fitness among hypertensives.

Keywords: Cerebrovascular reactivity, cognitive function, resistant hypertension, vascular endothelial function

DOI: 10.3233/JAD-215522

Journal: Journal of Alzheimer's Disease, vol. 87, no. 1, pp. 345-357, 2022