INS NYC 2024 Program

Poster	Poster Session 08 Program Schedule 02/16/2024 01:45 pm - 03:00 pm Room: Majestic Complex (Posters 61-120) Poster Session 08: Cognition \| Cognitive Reserve Variables Final Abstract #66 Lifestyle Modification and Cerebrovascular Health in Resistant Hypertension: Examining Treatment-Related Correlates of Improved Cerebrovascular Reactivity Patrick Smith, University of North Carolina, Chapel hill, United States Andrew Sherwood, Duke University Medical Center, Durham, United States Forgive avorgbedor, University of North Carolina, Greensboro, United States Krista Ingle, Duke University Medical Center, Durham, United States Pao-Hwa Lin, Duke University Medical Center, Durham, United States Stephanie Mabe, Duke University Medical Center, Durham, United States Alan Hinderliter, University of North Carolina, Chapel Hill, United States James Blumenthal, Duke University Medical Center, Durham, United States Category: Stroke/Cerebrovascular Injury and Disease (Adult) Keyword 1: cerebrovascular disease Keyword 2: hypertension Keyword 3: treatment outcome Objective: Resistant hypertension (RH) has been shown to adversely impact cerebrovascular functioning and brain health. Lifestyle modification using physical activity, dietary modification, and behavioral weight loss has been recommended to improve blood pressure (BP) and brain health among hypertensives. No studies, to our knowledge, have examined mechanisms of improved cerebrovascular health following lifestyle modification. Participants and Methods: We conducted secondary analyses of changes in cerebrovascular reactivity among participants in the TRIUMPH randomized controlled trial. The TRIUMPH trial examined the effects of a cardiac rehabilitation-based lifestyle program (C-LIFE) compared with a standardized education and physician advice (SEPA) control condition for 4-months. At baseline and after 4-months, cerebrovascular reactivity (CVR) was obtained using functional near infrared spectroscopy during both a hypercapnic breath holding task and while performing three brief cognitive assessments (semantic fluency, phonemic fluency, and mental arithmetic), each lasting one-minute. Predictors of CVR changes included aerobic fitness (Peak VO₂), actigraphy-assessed physical activity, weight, ambulatory systolic blood pressure (ASBP), HbA1c, and microvascular function (forearm hyperemic response). Regression models controlled for age, biological sex, stroke risk, creatinine, and the baseline level of the respective outcome. Results: Participants included 140 middle-aged and older adults who were hypertensive and overweight at baseline (mean BMI = 36.0 [5.7]). Both groups demonstrated reductions in cerebrovascular reactivity following treatment (P = .021) despite better performance on cognitive testing paradigms, suggesting more efficient cerebral recruitment during cognitive test paradigms. Improvements in aerobic fitness (B = -0.26, P = .005), reduced ASBP (B = 0.24, P = .009), and weight loss (B = 0.17, P = .071) tended to associate with CVR during cognitive tasks. In contrast, CVR during hypercapnia associated with reduced HbA1c (B = -0.23, P = .011) and tended to be associated with increased actigraphy step count and improved microvascular function (B’s > -0.16, P = .083). Conclusions: Improvements in CVR associated with diverse lifestyle mechanisms, including improved aerobic fitness, reduced SBP, and improved metabolic functioning.

Poster

02/16/2024
01:45 pm - 03:00 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 08: Cognition | Cognitive Reserve Variables

Final Abstract #66

Lifestyle Modification and Cerebrovascular Health in Resistant Hypertension: Examining Treatment-Related Correlates of Improved Cerebrovascular Reactivity

Patrick Smith, University of North Carolina, Chapel hill, United States
Andrew Sherwood, Duke University Medical Center, Durham, United States
Forgive avorgbedor, University of North Carolina, Greensboro, United States
Krista Ingle, Duke University Medical Center, Durham, United States
Pao-Hwa Lin, Duke University Medical Center, Durham, United States
Stephanie Mabe, Duke University Medical Center, Durham, United States
Alan Hinderliter, University of North Carolina, Chapel Hill, United States
James Blumenthal, Duke University Medical Center, Durham, United States

Category: Stroke/Cerebrovascular Injury and Disease (Adult)

Keyword 1: cerebrovascular disease
Keyword 2: hypertension
Keyword 3: treatment outcome

Objective:

Resistant hypertension (RH) has been shown to adversely impact cerebrovascular functioning and brain health. Lifestyle modification using physical activity, dietary modification, and behavioral weight loss has been recommended to improve blood pressure (BP) and brain health among hypertensives. No studies, to our knowledge, have examined mechanisms of improved cerebrovascular health following lifestyle modification.

Participants and Methods:

We conducted secondary analyses of changes in cerebrovascular reactivity among participants in the TRIUMPH randomized controlled trial. The TRIUMPH trial examined the effects of a cardiac rehabilitation-based lifestyle program (C-LIFE) compared with a standardized education and physician advice (SEPA) control condition for 4-months. At baseline and after 4-months, cerebrovascular reactivity (CVR) was obtained using functional near infrared spectroscopy during both a hypercapnic breath holding task and while performing three brief cognitive assessments (semantic fluency, phonemic fluency, and mental arithmetic), each lasting one-minute. Predictors of CVR changes included aerobic fitness (Peak VO₂), actigraphy-assessed physical activity, weight, ambulatory systolic blood pressure (ASBP), HbA1c, and microvascular function (forearm hyperemic response). Regression models controlled for age, biological sex, stroke risk, creatinine, and the baseline level of the respective outcome.

Results:

Participants included 140 middle-aged and older adults who were hypertensive and overweight at baseline (mean BMI = 36.0 [5.7]). Both groups demonstrated reductions in cerebrovascular reactivity following treatment (P = .021) despite better performance on cognitive testing paradigms, suggesting more efficient cerebral recruitment during cognitive test paradigms. Improvements in aerobic fitness (B = -0.26, P = .005), reduced ASBP (B = 0.24, P = .009), and weight loss (B = 0.17, P = .071) tended to associate with CVR during cognitive tasks. In contrast, CVR during hypercapnia associated with reduced HbA1c (B = -0.23, P = .011) and tended to be associated with increased actigraphy step count and improved microvascular function (B’s > -0.16, P = .083).

Conclusions:

Improvements in CVR associated with diverse lifestyle mechanisms, including improved aerobic fitness, reduced SBP, and improved metabolic functioning.