Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia

Abstract

IMPORTANCE There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia. OBJECTIVE To evaluate the effect of intensive blood pressure control on risk of dementia. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20,2015. The final date for follow-up of cognitive outcomes was July 22, 2018. INTERVENTIONS Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683). MAIN OUTCOMES AND MEASURES The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia. RESULTS Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67–1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69–0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74–0.97). CONCLUSIONS AND RELEVANCE Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point.

Hypertension Management in Older and Frail Older Patients

“…The BP goal to reach in order to obtain the best prevention of the cognitive decline and dementia remains unknown. Recently published results of the SPRINT MIND study (Systolic Blood Pressure Intervention Trial/Memory and Cognition in Decreased Hypertension) 107 among adults with hypertension older than 50 years (average age 68 years) demonstrated that intensive BP control (SBP<120 mm Hg) compared with standard BP control (SBP<140 mm Hg) did not significantly reduce the risk of developing dementia. However, because of early study termination and fewer-thanexpected cases of dementia, the study might have been underpowered for this end point.…”

The Effect of Blood Pressure on Cognitive Performance. An 8-Year Follow-Up of the Tromsø Study, Comprising People Aged 45–74 Years

“…Although the McGuinness et al (2009) meta-analysis found no association between the lowering of BP and cognitive impairment, Tzourio et al (2003) found that reducing BP had a positive effect on cognition -but only by reducing the rate of stroke. A recent randomized clinical trial demonstrated that intensive SBP control can reduce the development of mild cognitive impairment (Williamson et al, 2019).…”

New targets and old therapies for arterial hypertension

“…В настоящее время такие данные вновь обращают на себя внимание в связи с недавно опубликованными результатами исследования SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension), в котором оценивали ИРТ и СРТ на риск развития вероятной деменции и умеренных когнитивных расстройств (УКР) [9]. Результаты этого исследования свидетельствовали о том, что у амбулаторных взрослых больных с АГ применение ИРТ с целевым уровнем САД менее 120 мм рт.…”