lisinopril and Cognition-Disorders

Topics: Age Factors; Aged; Benzimidazoles; Biphenyl Compounds; Blood Pressure Determination; Cognition; Cognition Disorders; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Hydrochlorothiazide; Hypertension; Lisinopril; Male; Middle Aged; Sex Factors; Tetrazoles; Treatment Outcome

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.

Topics: Antihypertensive Agents; Atenolol; Blood Pressure; Brain; Brain Mapping; Cerebrovascular Circulation; Cognition; Cognition Disorders; Female; Humans; Hypertension; Lisinopril; Magnetic Resonance Imaging; Male; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Positron-Emission Tomography; Regional Blood Flow; Tomography, Emission-Computed

Hypertension is associated with mild decrements in cognition. In addition, regional cerebral blood flow responses during memory processing are blunted in parietal and thalamic areas among untreated hypertensive adults, who, compared with normotensive subjects, manifest greater correlation in blood flow response across task-related brain regions. Here, we test whether pharmacological treatment of hypertension normalizes regional cerebral blood flow responses and whether it does so differentially according to drug class. Treatment with lisinopril, an angiotensin-converting enzyme blocker, known to enhance vasodilative responsivity, was compared with treatment with atenolol, a beta-blocker. Untreated hypertensive volunteers (n=28) were randomly assigned and treated for 1 year. Whole brain and regional cerebral flow responses to memory processing and acutely administered acetazolamide, a vasodilator, were assessed pretreatment and posttreatment. Peripheral brachial artery dilation during reactive hyperemia was also measured. Quantitative blood flow measures showed no difference in the magnitude of regional cerebral blood flow responses pretreatment and posttreatment to either memory tasks or acetazolamide injection. Brachial artery flow-mediated dilation increased with treatment. No differences between medications were observed. In brain regions active in memory processing, however, regional cerebral blood flow responses were more highly correlated after treatment. Specificity of cerebral blood flow to different regions appears to decline with treatment of hypertension. This greater correlation among active brain regions, which is present as well in untreated hypertensive relative to normotensive volunteers, may represent compensation in the face of less region-specific responsivity in individuals with hypertension.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Analysis of Variance; Angiotensin-Converting Enzyme Inhibitors; Atenolol; Blood Pressure; Brachial Artery; Brain; Cerebrovascular Circulation; Cognition; Cognition Disorders; Female; Heart Rate; Humans; Hypertension; Lisinopril; Male; Memory; Middle Aged; Vasodilation

Hypertension appears to alter brain morphology, as well as the cerebrovascular support for information processing. Because these effects might reflect progressive effects of essential hypertension on the brain, we asked whether structural and functional brain indices would predict the success of pharmacological treatment of hypertension among 45 previously unmedicated individuals. After initial structural MRI and functional positron emission tomography imaging, subjects were randomly assigned in a double-blind fashion for treatment for 1 year with either lisinopril or atenolol. Systolic and diastolic blood pressure decreases after treatment stabilization were correlated to a pretreatment index of brain aging (combined ratings of ventricle and sulcal size and white matter hyperintensities) and the pretreatment change in regional cerebral blood flow during working memory in the thalamus and posterior parietal regions of interest. In multiple regression analyses, the structural brain index and the blood flow response in the thalamus predicted 20% of the variance in the systolic blood pressure response to treatment controlling for pretreatment blood pressure, age, gender, and type and dose of medication. Alcohol use influenced the thalamic response measure, but covariates did not alter the relation between greater indices of brain aging and less successful blood pressure response to treatment. The state of the brain may be an important factor in the remediation of blood pressure.

Topics: Aging; Antihypertensive Agents; Atenolol; Blood Pressure; Brain; Cerebrovascular Circulation; Cognition Disorders; Female; Humans; Hypertension; Lisinopril; Magnetic Resonance Imaging; Male; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Positron-Emission Tomography; Predictive Value of Tests; Regression Analysis

Topics: Benzimidazoles; Cognition; Cognition Disorders; Female; Humans; Hydrochlorothiazide; Hypertension; Lisinopril; Male; Tetrazoles