William B. White, MD, on the Results of INFINITY
In elderly individuals, lowering blood pressure prevents worsening brain damage, according to research presented at the American College of Cardiology’s 68th Annual Scientific Session.
The preliminary results of the Intensive versus Standard Ambulatory Blood Pressure Lowering to Lessen Functional Decline in the Elderly Trial (INFINITY)1 were presented by lead author William B. White, MD, who is professor of medicine and chief of the Hypertension and Clinical Pharmacology Department in the Calhoun Cardiology Center at the UConn Health Center in Farmington, Connecticut.
Cardiology Consultant caught up with Dr White after the session to ask him 5 of our burning questions.
CARDIOLOGY CON: To start, can you tell us more about your research and what you found?
William B. White: Our study1 was based on a prior observation that older people who had small vessel disease of the brain, represented by white matter hyperintensity lesions on magnetic resonance imaging (MRI) scan, developed functional decline that was also associated with varying levels of 24-hour systolic blood pressure (BP)—not office BP. We conducted a randomized trial of 2 levels of 24-hour systolic BP, which was also the way we guided drug therapy. The intensive-treated group had a goal of less than 130 mmHg, and the standard-treatment group had a goal of 145 mmHg.
CARDIO CON: Did any of your findings surprise you?
WBW: We were disappointed that none of our mobility parameters were different between the 2 treatment groups, despite a substantial difference in the accumulation of white matter lesions favoring the intensive-treatment group. Another surprise was that even in our relatively small trial, the number of major non-fatal cardiovascular events was much lower in the intensive-treatment group than in the standard group.
CARDIO CON: What do your results mean for clinical practice?
WBW: It appears that an average systolic BP of 130 mmHg is an appropriate one for older people; there is less progression of vascular disease, and it is safer than higher levels of systolic BP.
CARDIO CON: What else should our audience of cardiologists know about your research?
WBW: From the INFINITY population, the relations among ambulatory, home, and clinic BP with white matter disease and functional tests in these older people showed that home BP was very much less likely to be associated with target organ disease than the other 2 methods of BP measurement.
CARDIO CON: What is the next step in your research? What else are you investigating?
WBW: We have a very large amount of data from INFINITY; we will be analyzing relations longitudinally between different types of BP and outcomes, regions of the brain most likely to be affected by hypertension, and microstructural integrity of the brain using diffusion tensor imaging as it relates to functional disability and cardiovascular risk factors.
Reference:
- White WB. Primary results of the Intensive versus Standard Ambulatory Blood Pressure Lowering to Lessen Functional Decline in the Elderly Trial (INFINITY). Paper presented at: American College of Cardiology’s 68th Annual Scientific Session; March 16-18, 2019; New Orleans, LA. https://www.abstractsonline.com/pp8/#!/5758/presentation/58371.