Blood pressure variability compromises vascular function in middle-aged mice

Reviewer #1 (Public review):

This study examined the effect of blood pressure variability on brain microvascular function and cognitive performance. By implementing a model of blood pressure variability using an intermittent infusion of AngII for 25 days, the authors examined different cardiovascular variables, cerebral blood flow, and cognitive function during midlife (12-15-month-old mice). Key findings from this study demonstrate that blood pressure variability impairs baroreceptor reflex and impairs myogenic tone in brain arterioles, particularly at higher blood pressure. They also provide evidence that blood pressure variability blunts functional hyperemia and impairs cognitive function and activity. Simultaneous monitoring of cardiovascular parameters, in vivo imaging recordings, and the combination of physiological and behavioral studies reflect rigor in addressing the hypothesis. The experiments are well-designed, and the data generated are clear. I list below a number of suggestions to enhance this important work:

(1) Figure 1B: It is surprising that the BP circadian rhythm is not distinguishable in either group. Figure 2, however, shows differences in circadian rhythm at different timepoints during infusion. Could the authors explain the lack of circadian effect in the 24-h traces?

(2) While saline infusion does not result in elevation of BP when compared to Ang II, there is an evident "and huge" BP variability in the saline group, at least 40mmHg within 1 hour. This is a significant physiological effect to take into consideration, and therefore it warrants discussion.

(3) The decrease in DBP in the BPV group is very interesting. It is known that chronic Ang II increases cardiac hypertrophy, are there any changes to heart morphology, mass, and/or function during BPV? Can the the decrease in DBP in BPV be attributed to preload dysfunction? This observation should be discussed.

(4) Examining the baroreceptor reflex during the early and late phases of BPV is quite compelling. Figures 3D and 3E clearly delineate the differences between the two phases. For clarity, I would recommend plotting the data as is shown in panels D and E, rather than showing the mathematical ratio. Alternatively, plotting the correlation of ∆HR to ∆SBP and analyzing the slopes might be more digestible to the reader. The impairment in baroreceptor reflex in the BPV during high BP is clear, is there any indication whether this response might be due to loss of sympathetic or gain of parasympathetic response based on the model used?

(5) Figure 3B shows a drop in HR when the pump is ON irrespective of treatment (i.e., independent of BP changes). What is the underlying mechanism?

(6) The correlation of ∆diameter vs MAP during low and high BP is compelling, and the shift in the cerebral autoregulation curve is also a good observation. I would strongly recommend that the authors include a schematic showing the working hypothesis that depicts the shift of the curve during BPV.

(7) Functional hyperemia impairment in the BPV group is clear and well-described. Pairing this response with the kinetics of the recovery phase is an interesting observation. I suggest elaborating on why BPV group exerts lower responses and how this links to the rapid decline during recovery.

(8) The experimental design for the cognitive/behavioral assessment is clear and it is a reasonable experiment based on previous results. However, the discussion associated with these results falls short. I recommend that the authors describe the rationale to assess recognition memory, short-term spatial memory, and mice activity, and explain why these outcomes are relevant in the BPV context. Are there other studies that support these findings? The authors discussed that no changes in alternation might be due to the age of the mice, which could already exhibit cognitive deficits. In this line of thought, what is the primary contributor to behavioral impairment? I think that this sentence weakens the conclusion on BPV impairing cognitive function and might even imply that age per se might be the factor that modulates the various physiological outcomes observed here. I recommend clarifying this section in the discussion.

(9) Why were only male mice used?

(10) In the results for Figure 3: "Ang II evoked significant increases in SBP in both control and BPV groups;...". Also, in the figure legend: "B. Five-minute average HR when the pump is OFF or ON (infusing Ang II) for control and BPV groups...." The authors should clarify this as the methods do not state a control group that receives Ang II.

Reviewer #2 (Public review):

Summary:

Blood pressure variability has been identified as an important risk factor for dementia. However, there are no established animal models to study the molecular mechanisms of increased blood pressure variability. In this manuscript, the authors present a novel mouse model of elevated BPV produced by pulsatile infusions of high-dose angiotensin II (3.1ug/hour) in middle-aged male mice. Using elegant methodology, including direct blood pressure measurement by telemetry, programmable infusion pumps, in vivo two-photon microscopy, and neurobehavioral tests, the authors show that this BPV model resulted in a blunted bradycardic response and cognitive deficits, enhanced myogenic response in parenchymal arterioles, and a loss of the pressure-evoked increase in functional hyperemia to whisker stimulation.

Strengths:

As the presentation of the first model of increased blood pressure variability, this manuscript establishes a method for assessing molecular mechanisms. The state-of-the-art methodology and robust data analysis provide convincing evidence that increased blood pressure variability impacts brain health.

Weaknesses:

One major drawback is that there is no comparison with another pressor agent (such as phenylephrine); therefore, it is not possible to conclude whether the observed effects are a result of increased blood pressure variability or caused by direct actions of Ang II. Ang II is known to have direct actions on cerebrovascular reactivity, neuronal function, and learning and memory. Given that Ang II is increased in only 15% of human hypertensive patients (and an even lower percentage of non-hypertensive), the clinical relevance is diminished. Nonetheless, this is an important study establishing the first mouse model of increased BPV.