Trial results for the Hypertension, Intracranial Pulsatility and Brain Amyloid-beta Accumulation in Older Adults (HIPAC Trial) were posted on ClinicalTrials.gov on 2025-07-02. The study found that intensive treatment for hypertension led to a mean reduction in brain white matter hyperintensity of 2.8 ml (Standard Deviation 3.2) compared to 7.9 ml (Standard Deviation 12.9) in the standard care group.
Background
Hypertension, or high blood pressure, is a common condition, particularly in older adults. It has been hypothesized to contribute to brain amyloid-beta protein accumulation, a hallmark of Alzheimer's disease, and to affect cognitive functions like memory and thinking. While lowering blood pressure is a standard clinical practice for cardiovascular health, its direct impact on reducing brain amyloid-beta protein and improving brain function has remained inconclusive. This study aimed to investigate whether antihypertensive medication could alter brain pulsatility and reduce amyloid-beta accumulation.
Trial design
This Phase 2, completed study enrolled 85 participants with Hypertension. The trial compared an intensive treatment approach, involving FDA-approved antihypertensive drugs to lower blood pressure, against a standard care group. The study's brief summary indicated an aim to determine if lowering blood pressure alters brain pulsatility and reduces brain amyloid-beta protein accumulation.
Key results
The study reported on several key measurements:
- Changes in Gray Matter Intracranial Pulsatility:
- Standard Care group: Mean change of -0.09 mm/cardiac cycle (Standard Deviation 0.04).
- Intensive Treatment group: Mean change of 0.02 mm/cardiac cycle (Standard Deviation 0.03).
- Changes in Overall Average 24 Hour Systolic Blood Pressure:
- Standard Care group: Mean decrease of 17.9 mmHg (Standard Deviation 3.3).
- Intensive Treatment group: Mean decrease of 23.6 mmHg (Standard Deviation 2.8).
- Changes in Overall Average 24hr Diastolic Blood Pressure:
- Standard Care group: Mean decrease of 10.9 mmHg (Standard Deviation 1.5).
- Intensive Treatment group: Mean decrease of 12 mmHg (Standard Deviation 1.2).
- Regional Cortical Thickness Via Magnetic Resonance Imaging (MRI):
- Standard Care group: Mean thickness of 2.3 mm (Standard Deviation 0.09).
- Intensive Treatment group: Mean thickness of 2.4 mm (Standard Deviation 0.08).
- Another measurement showed: Standard Care group: Mean thickness of 2.3 mm (Standard Deviation 0.09).
- Another measurement showed: Intensive Treatment group: Mean thickness of 2.3 mm (Standard Deviation 0.09).
- Brain White Matter Hyperintensity (WMH) Via Magnetic Resonance Imaging (MRI):
- Standard Care group: Mean volume of 7.9 ml (Standard Deviation 12.9).
- Intensive Treatment group: Mean volume of 2.8 ml (Standard Deviation 3.2).
What this means
The most notable finding from this Phase 2 trial is the significant difference observed in brain white matter hyperintensity (WMH) between the intensive treatment and standard care groups. Patients receiving intensive hypertension treatment showed a substantially lower mean WMH volume, suggesting a potential benefit of aggressive blood pressure management in mitigating this marker of cerebrovascular disease. While both groups experienced reductions in systolic and diastolic blood pressure, the intensive treatment group achieved a greater average decrease in systolic blood pressure. The changes in gray matter intracranial pulsatility and regional cortical thickness showed less pronounced or consistent differences between the groups. These results, from a relatively small Phase 2 study, indicate that intensive hypertension treatment may have a positive impact on brain white matter health in older adults, warranting further investigation in larger trials.
Source
The information for these trial results was obtained from ClinicalTrials.gov, a public database of clinical studies. The results for the study NCT03354143, titled "Hypertension, Intracranial Pulsatility and Brain Amyloid-beta Accumulation in Older Adults (HIPAC Trial)", were posted on 2025-07-02 on clinicaltrials.gov.