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Research ArticleFunctional
Open Access

Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial

C. Shah, D. Srinivasan, G. Erus, M. Kurella Tamura, M. Habes, J.A. Detre, W.E. Haley, A.J. Lerner, C.B. Wright, J.T. Wright, S. Oparil, S.B. Kritchevsky, H.A. Punzi, A. Rastogi, R. Malhotra, C.H. Still, J.D. Williamson, R.N. Bryan, Y. Fan and I.M. Nasrallah
American Journal of Neuroradiology May 2023, 44 (5) 582-588; DOI: https://doi.org/10.3174/ajnr.A7852
C. Shah
aFrom the Department of Radiology (C.S.), Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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D. Srinivasan
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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G. Erus
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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M. Kurella Tamura
cDivision of Nephrology (M.K.T.), Stanford University, and VA Palo Alto Geriatric Research and Education Clinical Center, Palo Alto, California
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M. Habes
dBiggs Institute, University of Texas San Antonio (M.H.), San Antonio, Texas
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J.A. Detre
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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W.E. Haley
eDepartment of Nephrology and Hypertension (W.E.H.), Mayo Clinic, Jacksonville, Florida
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A.J. Lerner
fDepartments of Neurology (A.J.L.)
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C.B. Wright
hNational Institute of Neurological Disorders and Stroke (C.B.W.), National Institutes of Health, Bethesda, Maryland
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J.T. Wright Jr
gMedicine (J.T.W.), Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio
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S. Oparil
iDivision of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham, Alabama
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S.B. Kritchevsky
jSection of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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H.A. Punzi
kPunzi Medical Center (H.A.P.), Carrollton, Texas
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A. Rastogi
lDivision of Nephrology (A.R.), Department of Medicine, University of California Los Angeles, Los Angeles, California
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R. Malhotra
mDivision of Nephrology (R.M.), University of California San Diego, San Diego, California
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C.H. Still
nFrances Payne Bolton School of Nursing (C.H.S.), Case Western Reserve University, Cleveland, Ohio
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J.D. Williamson
jSection of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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R.N. Bryan
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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Y. Fan
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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I.M. Nasrallah
bDepartment of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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    FIG 1.

    Flow diagram for SPRINT participants undergoing fMRI.

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    FIG 2.

    Voxelwise t test comparing the longitudinal change of the ASLN between treatment groups. Comparison t map on the right (red box) demonstrates regions of significantly more negative change with time in the standard group compared with the intensive group in the cingulate region and right posterior insula and temporal lobe. Clusters are significant to P < .0001 family-wise error–corrected. BL indicates baseline; FU, Follow-up.

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    Table 1:

    Characteristics of study cohort at baselinea

    Standard Treatment Group (n = 180)Intensive Treatment Group (n = 226)
    Follow-up period (median) (yr)3.863.82
    Age (yr)67.5 (SD, 8.4)68.4 (SD, 8.4)
    Female sex (No.) (%)60 (33.3%)89 (39.4%)
    Race (No.) (%)
     White117 (65.0%)156 (69.0%)
     Black51 (28.3%)59 (26.1%)
     Hispanic9 (5.0%)7 (3.1%)
     Other3 (1.7%)4 (1.8%)
    SBP (mm Hg)139.6 (SD, 18.4)136.2 (SD, 18.2)
    DBP (mm Hg)82.2 (SD, 13.2)80.2 (SD, 11.2)
    eGFR (mL/min/1.73 m2)69.1 (SD, 21.3)65.2 (SD, 19.0)
    Serum creatinine level (mg/dL)1.1 (SD, 0.4)1.1 (SD, 0.4)
    Chronic kidney disease (eGFR <60 mL/min/1.73 m2) (No.) (%)61 (33.9)88 (38.9)
    Framingham 10-year cardiovascular disease risk score (%)24.3 (SD, 12.4)23.5 (SD, 12.6)
    TBV (cm3)1150.9 (SD, 117.0)1139.3 (SD, 117.3)
    rTBV/ICV)0.82 (SD, 0.04)0.82 (SD, 0.04)
    White matter lesion volume (median) (IQR) (cm3)1.6 (0.9–3.8)1.4 (0.6–3.6)
    • Note:—DBP indicates diastolic blood pressure; IQR, interquartile range; eGFR, estimated glomerular rate; ICV, intracranial volume.

    • ↵a All values provided as means unless otherwise specified.

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    Table 2:

    Subgroup comparisons between treatment groups in longitudinal ΔMCS

    Default Mode NetworkASLN
    Standard GroupIntensive GroupEffect Size (Cohen d)tP ValueEffect Size (Cohen d)tP Value
    Overall180226–0.12–1.17.24–0.24–2.46.014a
    Subgroups
     High baseline WMH94108–0.14–0.97.33–0.28–2.03.044b
     Low baseline WMH85118–0.09–0.66.51–0.21–1.47.144
     High ΔWMH10196–0.08–0.55.59–0.24–1.67.097
     Low ΔWMH77127–0.12–0.86.39–0.27–1.86.064
     Older age97131–0.12–0.90.37–0.28–2.10.037b
     Younger age8395–0.11–0.73.47–0.19–.28.20
     Larger rTBV decline87117–0.32–2.27.024b–0.09–0.64.52
     Smaller rTBV decline931090.090.66.51–0.39–2.79.0058b
    • ↵a P <. 05, Bonferroni-corrected.

    • ↵b P <. 05, uncorrected.

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    Table 3:

    Multiple variable linear regression parameters for models of longitudinal ΔMCS

    PredictorsΔMCS Model Parameters
    Default Mode Network ModelASLN Model
    βP ValueβP Value
     ΔWMH–7.86 ×10−7.0137.21 ×10−7.067
     ΔrTBV0.14.0300.1106.17
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American Journal of Neuroradiology: 44 (5)
American Journal of Neuroradiology
Vol. 44, Issue 5
1 May 2023
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C. Shah, D. Srinivasan, G. Erus, M. Kurella Tamura, M. Habes, J.A. Detre, W.E. Haley, A.J. Lerner, C.B. Wright, J.T. Wright, S. Oparil, S.B. Kritchevsky, H.A. Punzi, A. Rastogi, R. Malhotra, C.H. Still, J.D. Williamson, R.N. Bryan, Y. Fan, I.M. Nasrallah
Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial
American Journal of Neuroradiology May 2023, 44 (5) 582-588; DOI: 10.3174/ajnr.A7852

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BP Management & Connectivity in Hypertension
C. Shah, D. Srinivasan, G. Erus, M. Kurella Tamura, M. Habes, J.A. Detre, W.E. Haley, A.J. Lerner, C.B. Wright, J.T. Wright, S. Oparil, S.B. Kritchevsky, H.A. Punzi, A. Rastogi, R. Malhotra, C.H. Still, J.D. Williamson, R.N. Bryan, Y. Fan, I.M. Nasrallah
American Journal of Neuroradiology May 2023, 44 (5) 582-588; DOI: 10.3174/ajnr.A7852
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