Hypertension, Intracranial Pulsatility and Brain Amyloid-beta Accumulation in Older Adults (HIPAC Trial)

Study Overview
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Brief Summary
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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.

Official Title
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Hypertension, Intracranial Pulsatility and Brain Amyloid-beta Accumulation in Older Adults (HIPAC Trial)

Conditions
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Hypertension

Intervention / Treatment
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* Drug: Standard Care
* Drug: Intensive Treatment


Participation Criteria
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Eligibility Criteria
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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; Regularly smoking cigarette within the past year; Severe obesity with BMI ≥ 45; Participants enrolled in another investigational drug or device study within the past 2 months; Carotid stent or sever stenosis (> 50%); Pacemaker or other medical device of metal that precludes performing MRI; History of B12 deficiency or hypothyroidism (stable treatment for at least 3 months is allowable); Any conditions judged by the study investigators to be either medically inappropriate, or risky for participant or likely to have poor study adherence; Claustrophobia; Pregnancy

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Care<br>Subjects in the standard care arm will receive calcium channel blocker (CCB, amlodipine), angiotensin II receptor blocker (ARB, losartan), and other antihypertensive drugs to reduce 24-hour SBP ≤ 130 mmHg. Drug doses will be titrated to reach the BP target. | Drug: Standard Care<br>* Calcium channel blocker (CCB, amlodipine), angiotensin II receptor blocker (ARB, losartan), and other antihypertensive drugs will be used to reduce 24-hour SBP ≤ 130 mmHg.<br>|
| Experimental: Intensive Treatment<br>Subjects in the intensive treatment arm will receive calcium channel blocker (CCB, amlodipine), angiotensin II receptor blocker (ARB, losartan), and other antihypertensive drugs to reduce 24-hour SBP ≤ 120 mmHg. | Drug: Intensive Treatment<br>* Calcium channel blocker (CCB, amlodipine), angiotensin II receptor blocker (ARB, losartan), and other antihypertensive drugs will be used to reduce 24-hour SBP ≤ 120 mmHg.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in intracranial pulsatility | Changes in intracranial pulsatility will be measured with CINE phase-contrast MRI | Baseline and 12-months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebrospinal fluid Amyloid-β and tau |  | Baseline and 12-months | 
| Global and regional brain perfusion via Magnetic Resonance Imaging (MRI) |  | Baseline and 12-months | 
| Regional brain volume via Magnetic Resonance Imaging (MRI) |  | 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 | 
| Brain neural network functional connectivity via Magnetic Resonance Imaging (MRI) |  | Baseline and 12-months | 
| NIH-Toolbox neurocognitive function |  | Baseline, 6-months,12-months | 
| NIH PROMIS patient-reported outcome measures of physical health |  | Baseline, 6-months, 12-months | 
| NIH PROMIS patient-reported outcome measures of mental health |  | Baseline, 6-months, 12-months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dementia, Alzheimer's Disease, Blood Pressure, Cognitive Function, Magnetic Resonance Imaging