Lifestyle changes improve cognition among people with resistant hypertension

Individuals with resistant hypertension who undergo lifestyle modification have better cognitive function, and this benefit may be attributed to the reduced ambulatory systolic blood pressure (SBP) changes through weight loss, suggests a study.

In addition, “[c]ognitive improvements were accompanied by parallel improvements in endothelial and microvascular function,” the authors said.

One hundred forty patients with resistant hypertension (mean age 63 years, mean body mass index 36 kg/m², 48 percent women, 59 percent Black) participating in the TRIUMPH trial were included in the analysis. They were randomized to either a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA).

All participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. The authors also collected biomarkers of vascular (flow mediated dilation of the brachial artery [FMD]), microvascular, and cerebrovascular function, as well as weight, fitness, and ambulatory BP.

During the 4-month trial, cognitive performance improved across the entire cohort (pretreatment vs post-treatment t-scores: 48.9 vs 40.0; p<0.001). Participants in C-LIFE showed higher postintervention executive function/learning composite performance than those in SEPA (d, 0.37; p=0.039).

Sex (p=0.026) and baseline stroke risk (p=0.043) moderated the effects of C-LIFE intervention on memory and processing speed. Specifically, males and participants with a higher stroke risk exhibited the biggest cognitive changes.

C-LIFE led to better FMD (0.3 percent vs ‒1.4 percent; p=0.022) and microvascular function (97 vs 0.25; p<0.001) compared with SEPA, but not cerebrovascular reactivity (‒0.2 vs 0.1; p=0.197).

In mediation analyses, higher executive function/learning correlated with lower ambulatory SBP levels secondary to weight loss (indirect effect: B, 0.25).

“Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia,” the authors said.