Hypertension, Intracranial Pulsatility and Brain Amyloid-beta Accumulation in Older Adults (HIPAC Trial)
Overview
- Phase
- Phase 2
- Intervention
- Not specified
- Conditions
- Hypertension
- Sponsor
- University of Texas Southwestern Medical Center
- Enrollment
- 85
- Locations
- 1
- Primary Endpoint
- Changes in Gray Matter Intracranial Pulsatility
- Status
- Completed
- Last Updated
- 10 months ago
Overview
Brief Summary
The aim of this study is to determine if lowering blood pressure using FDA approved medication (antihypertensive drugs) alters brain pulsatility and reduces brain amyloid beta protein accumulation in older adults. Amyloid beta protein is high in the brain of older adults with Alzheimer's disease. Hypertension may increase brain amyloid beta protein accumulation and affect memory and thinking ability in older adults. However, whether lowering blood pressure reduces brain amyloid beta protein and improves brain function is inconclusive.
The investigators hypothesize that treating high blood pressure alters brain pulsatility, which in turn reduces brain amyloid beta protein accumulation and improves brain structure and function.
Investigators
Rong Zhang
Professor of Neurology
University of Texas Southwestern Medical Center
Eligibility Criteria
Inclusion Criteria
- •Age 55-79, all races/ethnicities, and both women and men are eligible;
- •Mini-mental state exam (MMSE) \> 26 to exclude cognitive impairment or dementia;
- •Healthy normotensive subjects (24-hour ambulatory BP\<125/75 mmHg without use of antihypertensive medication);
- •Patients with hypertension defined as 24-hour SBP ≥130 mmHg , patients on BP medications are eligible;
- •Patients with hypertension are willing to be randomized into either treatment group and ability to return to clinic or laboratory for follow-up visits over 12 months;
- •Fluency in English, adequate visual and auditory acuity to allow neuropsychological testing;
- •Screening laboratory tests and ECG without significant abnormalities that might interfere with the study
Exclusion Criteria
- •History of stroke, transient ischemic attack, traumatic brain injury or severe cerebrovascular disease by clinical diagnosis or past MRI/CT;
- •Diagnosis of AD or other type of dementia and neurodegenerative diseases;
- •Evidence of severe depression or other DSM-V Axis I psychopathology
- •Unstable heart disease based on clinical judgment (heart attack/cardiac arrest, cardiac bypass procedures within previous 6 months and congestive heart failure), evidence of atrial fibrillation on ECG, or other severe medical conditions;
- •Chronic kidney diseases with GFR \< 40 ml/min;
- •Orthostatic hypotension, defined as standing SBP\<100 mmHg;
- •History of significant autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis and polymyalgia rheumatica;
- •History of drug or alcohol abuse within the last 2 years;
- •Diagnosis of uncontrolled diabetes mellitus (fasting blood sugar ≥126 mg/dL or A1C \>7.5%)
- •Obstructive sleep apnea;
Outcomes
Primary Outcomes
Changes in Gray Matter Intracranial Pulsatility
Time Frame: Baseline and 12-months
Changes (12 month timepoint minus baseline) in intracranial pulsatility will be measured with CINE phase-contrast MRI. We will use the velocity-encoded CINE PC MRI to measure intracranial pulsatility. Pulsatility measured in mm per cardiac cycle
Secondary Outcomes
- NIH PROMIS Patient-reported Outcome Measures of Physical Health(Baseline and 12-months)
- Brain Neural Network Functional Connectivity Via Magnetic Resonance Imaging (MRI)(Baseline and 12-months)
- NIH PROMIS Patient-reported Outcome Measures of Mental Health(Baseline and 12-months)
- Changes in Overall Average 24 Hour Systolic Blood Pressure(Baseline and 12-months)
- Changes in Overall Average 24hr Diastolic Blood Pressure(Baseline and 12-months)
- Regional Cortical Thickness Via Magnetic Resonance Imaging (MRI)(Baseline and 12-months)
- Brain White Matter Hyperintensity (WMH) Via Magnetic Resonance Imaging (MRI)(Baseline and 12-months)
- Brain White Matter Microstructural Integrity Via Magnetic Resonance Imaging (MRI)(Baseline and 12-months)