Brainstem networkconnectivity with mid-anterior insula predicts lower systolic blood pressure at rest in older adults with hypertension.

Abstract

Central regulation of heart rate and blood pressureprovides the bases for a neurogenic mechanism of hypertension (HTN). Post menopause (PM) age coincides with changes inresting state functional brain connectivity (rsFC) as well as increased risk for HTN. Whether the neural networks underpinning cardioautonomic control differ between PM women with and without HTN is unclear. Phenotypic and functional neuroimaging data from the Nathan Kline Institute was first evaluated for group differences in intrinsic network connectivity between 22 HTN post menopausal women and 22 normotensive controls. Intrinsic rsFC of the midbrain-brainstem-cerebellar network with bilateral mid-anterior insula was lower in women withHTN (FWE-corrected, p < 0.05). Z-scores indicating rsFCof these regions were extracted from the 44 PMwomen and a cohortof 111 adults, not presenting with metabolic or neurodegenerative disease, and compared to in-office systolic and diastolic blood pressure. Lower rsFC of theleft (r = -0.17, p = 0.019) and right (r = -0.14, p = 0.048) mid-anterior insulawith brainstem nuclei was associated with higher systolic blood pressure in the combinedsample. The magnitude of thiseffect in men and women of post menopausal age supports a neurogenic mechanism for blood pressure regulation in older adultswith HTN.