Effects of intensive versus standard blood pressure control on domain-specific cognitive function: a substudy of the SPRINT randomised controlled trial

Rapp, Stéphen R.; Gaussoin, Sarah A.; Sachs, Bonnie C.; Chelune, Gordon J.; Supiano, Mark A.; Lerner, Alan J.; Wadley, Virginia G.; Wilson, Valarie M; Fine, Lawrence J.; Whittle, Jeff; Auchus, Alexander P.; Beddhu, Srinivasan; Berlowitz, Dan R.; Bress, Adam P.; Johnson, Karen C.; Krousel‐Wood, Marie; Martindale‐Adams, Jennifer; Miller, Eliza C.; Rifkin, Dena E.; Snyder, Joni K.; Tamariz, Leonardo; Wolfgram, Dawn; Cleveland, Maryjo; Yang, Mia; Nichols, Linda O.; Reboussin, David M.; Williamson, Jeff D.; Pajewski, Nicholas M.; Cheung, Alfred K.; Coker, Laura H.; Crowe, Michael; Cushman, William C.; Cutler, Jeffery A.; Davatzikos, Christos; Desiderio, Lisa; Doshi, Jimit; Erus, Güray; Harris, Darrin; Kimmel, Paul L.; Tamura, Manjula Kurella; Launer, Lenore J.; Lewis, Cora E.; Moy, Claudia S.; Oparil, Suzanne; Ogrocki, Paula; Rahman, Mahboob; Nasrallah, Ilya M.; Rocco, Michael V.; Sink, Kaycee M.; Still, Carolyn H; Walker, Jennifer; Weiner, Daniel E.; Whelton, Paul K.; Wilson, Valerie; Woolard, Nancy; Wright, Jackson T.; Wright, Clinton B.; Bryan, R. Nick

doi:10.1016/s1474-4422(20)30319-7

Cited by 62 publications

(65 citation statements)

References 30 publications

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“…A multiplicity of studies have demonstrated that age is a relevant predictor of progression and mortality 5 , 7 , 22 , 23 , which is confirmed by the results of this study (OR 1.06 CI 1.03, 1.09; p = 0.000). This may be explained by age-related effects on T- and B-cell function and the excessive production of type 2 cytokines.…”

Section: Discussionsupporting

confidence: 90%

“…Nevertheless, a relationship was not observed with ischemic heart disease. A variety of studies have established a relationship between diabetes and disease progression 5 , 7 , 22 , 23 , 26 . In our case, COVID-19 pneumonia was five-fold more likely to progress to severe disease in patients with diabetes (OR 5.20 CI 2.61, 10.35; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients

Gudé

Riveiro

Rodríguez-Núñez

et al. 2020

Sci Rep

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The prognosis of a patient with COVID-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with COVID-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, laboratory, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1152 patients presented with SARS-CoV-2 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 h of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤ 5%, 6–25%, and > 25% exhibited disease progression, respectively. A risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients

Gudé

Riveiro

Rodríguez-Núñez

et al. 2020

Sci Rep

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“…However, no statistically significant reduction was seen for probable dementia alone with a systolic blood pressure target of < 120 mmHg versus < 140 mg. In a substudy analysis, 165 no difference was seen in either memory or processing speed. Lane et al 166 reported, in a pathology study, that poorly controlled blood pressure from early adulthood into midlife, was associated with increased WMH volume and smaller brain volumes at ages 69 to 71.…”

Section: Prevention and Treatmentmentioning

confidence: 84%

Emerging Concepts in Vascular Dementia: A Review

Bir

Khan

Javalkar

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

106

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Objective: Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. Materials and methods: A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. Results: VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. Conclusions: This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.

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“…Overall, our search yielded 10 835 citations, of which 7755 were screened after duplicate removal ( Figure 1 ). Five randomized clinical trials (ACCORD BP, 27 , 28 SPS3, 29 , 30 SPRINT, 15 , 31 , 32 , 33 , 34 PODCAST, 35 , 36 , 37 and INFINITY 38 , 39 ) from 14 publications and 2 protocols from ongoing and upcoming trials (ESH-CHL-SHOT 40 and IBIS 41 ) met eligibility criteria for inclusion.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Intensive vs Standard Blood Pressure Reduction and Association With Cognitive Decline and Dementia

et al. 2021

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Key Points Question Is intensive blood pressure reduction associated with lower rates of cognitive decline and dementia? Findings In this systematic review and meta-analysis of 5 randomized clinical trials with 17 396 participants, there was no significant association of lower blood pressure targets vs standard blood pressure management with the incidence of cognitive decline, dementia, and mild cognitive impairment in middle-aged and older adults with hypertension. Meaning These findings suggest that current evidence does not support intensive blood pressure reduction as a preventive strategy for cognitive decline and dementia.

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Effects of intensive versus standard blood pressure control on domain-specific cognitive function: a substudy of the SPRINT randomised controlled trial

Cited by 62 publications

References 30 publications

Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients

Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients

Emerging Concepts in Vascular Dementia: A Review

Evaluation of Intensive vs Standard Blood Pressure Reduction and Association With Cognitive Decline and Dementia

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