While scientists have long studied the detrimental effects of high blood pressure on cardiovascular function, its effects on the brain are less understood.
A new study from UT Health San Antonio, the academic health campus of The University of Texas at San Antonio (UT San Antonio) shows that even a small decrease in blood pressure can have a positive effect in delaying the progression of cerebral small vessel disease. Small vessel disease is a major factor in strokes, cognitive decline, dementia and other diseases prevalent in old age.
“If you want to keep your brain healthy, you want to avoid aging of the brain by keeping blood pressure in normal range,” said Mohamad Habes, PhD, director of the neuroimaging core at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases.
The study was published in September in eClinicalMedicine, part of The Lancet Discovery Science suite of open access journals. The research team includes principal investigator Habes, first author Sokratis Charisis, MD, a neurology fellow at Harvard University and graduate of UT San Antonio’s Joe R. and Teresa Lozano Long School of Medicine.
Post-hoc analysis of SPRINT clinical trials
The team conducted a post-hoc analysis of randomized clinical data from the Systolic Blood Pressure Intervention Trial (SPRINT).
They found that managing blood pressure at a 120 millimeters of mercury (mmHG) systolic target, rather than the traditional 140 mmHG target, can reduce the progression of cerebral small vessel disease by nearly 40%.
The findings point to the significant impact blood pressure can have on brain health, specifically small vessel disease.
Rather than looking at a single aspect of changes in brain health due to blood pressure, this study investigated the combined effect of three markers — periventricular white matter hyperintensities, white matter free water and basal ganglia perivascular spaces. Together, these markers show how keeping blood pressure under control leads to improvements in brain health, such as preventing fluid leaks, avoiding scar-like lesions and maintaining the brain waste clearance system.
“We found that the impact when all markers are considered together becomes more visible and easier to track compared to a single marker,” said Habes.
Novel multi-biomarker framework
Charisis developed a formula based on these markers to calculate how much of a decrease in blood pressure lowers the progression of small vessel disease.
“Prior studies show the magnitude of the blood pressure decrease was important when looking at cardiovascular outcomes, like heart attack, heart failure and mortality from heart-related disease. We show there is a similar trajectory in the brain where the higher the decrease in blood pressure, the greater potential benefit to brain blood vessels,” Charisis said.
Small changes, big benefits
The team also found that even a relatively small decrease in blood pressure showed measurable benefits for slowing small vessel disease.
“Some older people may have multiple comorbidities that make a dramatic decrease in blood pressure difficult. Even a small decrease in blood pressure can offer protection against small vessel disease,” said Charisis.
In the study, the researchers found a systolic blood pressure decrease of:
- 0-10 mmHG correlated with a 21.2% decrease in SVD progression
- 10-20 mmHG correlated with a 26.3% decrease
- Greater than 20 mmHG correlated with a 39.4% decrease
“Your blood pressure numbers today are a direct preview of your brain health tomorrow. Small vessel disease can lead to dementia. Lower blood pressure could have a meaningful improvement in cognitive health,” said Habes.
The research team said they plan to continue to refine this framework and develop similar ones that can tell them more about the mechanisms of the brain that can lead to dementia and how to prevent it.
“Prevention is important, slowing down brain aging is important and this study supports that,” Habes said.
Charisis S, Pajewski N, Price L et al. Intensive versus standard blood pressure control and overall brain small vessel disease burden: a post-hoc analysis of the SPRINT randomized clinical trial. eClinicalMedicine, September 2026; 99.