Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension.

Andrew Sherwood, Forgive Avorgbedor, James A Blumenthal, Alan Hinderliter, Krista Ingle, Pao-Hwa Lin, Linda Craighead, Crystal Tyson, William Kraus, Patrick J Smith

Journal: Journal of clinical hypertension (Greenwich, Conn.) 2023;25(1):106-110

PMID: 36541028

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Plain Language Summary

Hypertension is one of the primary causes of cardiovascular disease, stroke, Alzheimer’s Disease, and Alzheimer’s Disease and related dementias (AD/ADRD). Among individuals with hypertension, those with resistant hypertension (RH) appear to have the greatest risk of cerebrovascular disease and associated cognitive impairment. The aim of this study was to investigate the potential influence of individual differences in pre-treatment inflammatory profiles on changes in cognition following lifestyle modification among RH participants in the TRIUMPH clinical trial. This study is a report based on the TRIUMPH study which was a randomised clinical trial. One hundred forty patients with RH were randomised with 2:1 allocation to either a 4-month Centre-based Lifestyle intervention or Standardized Education and Physician Advice. Results show that basal levels of elevated peripheral inflammation may represent an intermediate phenotype of risk for cognitive decline. In fact, individuals with higher levels of c-reactive protein at baseline demonstrated greater improvements in Executive Function/Learning following participation in an intensive lifestyle intervention. Authors conclude that their findings may help inform targeted treatments to reduce ADRD among middle-aged and older adults with cardiovascular disease risk factors.

Abstract

Individuals with resistant hypertension (RH) have the greatest risk of cerebrovascular disease and cognitive impairment among individuals with hypertension. Elevated levels of pro-inflammatory cytokines may represent a critical yet unexamined factor influencing the impact of healthy lifestyle changes on cognitive function. We explored the influence of inflammation on changes in cognition following lifestyle modification among individuals with RH participating in the TRIUMPH clinical trial. One hundred forty participants with RH completed a battery of neurocognitive tests along with the inflammatory marker C-reactive protein (hsCRP) and were subsequently randomized to an intensive 4-month lifestyle modification intervention or to education and physician advice control. Results indicated that the effects of lifestyle modification on Executive Function and Learning were moderated by pre-intervention hsCRP levels (P = .049), with treatment efficacy increasing across levels of baseline inflammation levels (low: d = 0.12; mild: d = 0.43; moderate: d = 0.81). We conclude that inflammatory profiles may help identify individuals more likely to improve executive functioning resulting from lifestyle modification.

Address: School of Nursing, University of North Carolina at Greensboro, North Carolina, USA.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.; Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.; Department of Psychology, Emory University, Atlanta, Georgia, USA.

DOI: 10.1111/jch.14591