Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial

Pajewski, Nicholas M.; Berlowitz, Dan R.; Bress, Adam P.; Callahan, Kathryn E.; Cheung, Alfred K.; Fine, Larry; Gaussoin, Sarah A.; Johnson, Karen C.; King, Jordan B.; Kitzman, Dalane W.; Kostis, John B.; Lerner, Alan J.; Lewis, Cora E.; Oparil, Suzanne; Rahman, Mahboob; Reboussin, David M.; Rocco, Michael V.; Snyder, Joni K.; Still, Carolyn H; Supiano, Mark A.; Wadley, Virginia G.; Whelton, Paul K.; Wright, Jackson T.; Williamson, Jeff D.

doi:10.1111/jgs.16272

Cited by 65 publications

(43 citation statements)

References 39 publications

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“…After four years, the participants in the intensive blood pressure control group had a smaller increase in cerebral white matter lesions compared to the participants in the standard blood pressure control group [232]. Overall, the SPRINT-MIND trial highlights the potential for early and aggressive blood pressure lowering interventions to have a positive impact on the cerebrovascular health of older adults, which may lower risk of cognitive impairment [228,231,232].…”

Section: Consensus Recommendationsmentioning

confidence: 99%

“…Intensive blood pressure control in participants over 80 years old was associated with a greater risk of developing hypotension and possibly syncope, but was not associated with a higher risk of falls as compared to the standard blood pressure control group [ 230 ]. In most participants over 80 with at least three co-morbidities, intensive blood pressure control was associated with decreased risk of major cardiovascular events, MCI, and death [ 231 ].…”

Section: Promoting Successful Cognitive Agingmentioning

confidence: 99%

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Promoting Successful Cognitive Aging: A Ten-Year Update

Krivanek

Gale

McFeeley

et al. 2021

JAD

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A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.

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Section: Consensus Recommendationsmentioning

confidence: 99%

Section: Promoting Successful Cognitive Agingmentioning

confidence: 99%

Promoting Successful Cognitive Aging: A Ten-Year Update

Krivanek

Gale

McFeeley

et al. 2021

JAD

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“…However, the authors acknowledged that their findings may not have been statistically adequate, as the study ended prematurely with fewer cases of dementia than expected. Interestingly, a recently published secondary analysis of the Systolic Blood Pressure Intervention Trial showed that for patients aged  80 years with hypertension and no T2DM, intensive SBP control of < 120 mmHg compared to standard SBP control < 140 mmHg lowered the risk of major cardiovascular events, mild cognitive impairment (MCI), and death, with increased risk of changes in kidney function [19]. However, no incidence of dementia was observed.…”

Section: Hypertension Treatment Target Bp and Cognitive Function In The Elderly With Hypertensionmentioning

confidence: 99%

Effects of Antihypertensive Drugs on Cognitive Function in Elderly Patients with Hypertension: A Review

Yang

Luo

et al. 2021

Aging and disease

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Hypertension is a common comorbidity that contributes to the development of various cardiovascular disorders in elderly patients. Moreover, hypertension has been associated with cognitive decline and dementia. Cognitive impairment leads to increased morbidity and mortality in elderly patients with hypertension. However, previous studies investigating the association between blood pressure (BP), BP variability (BPV), and antihypertensive drug use and the risk of cognitive impairment in elderly patients with hypertension have reported inconsistent findings. Given the global burden of hypertension, the aging population, and the low quality of life associated with cognitive impairment, a more comprehensive understanding of the association between hypertension and cognitive decline is needed. In this review, we summarized the current preclinical evidence and clinical research regarding the association of BP control, BPV, and antihypertensive drug use and cognitive function. We particularly focused on the differences among categories of antihypertensive drugs. We concluded that the correlation of BP and risk of cognitive function is non-linear and dependent on a patient's age. Intensive BP control is generally not recommended, particularly for the oldest-old. Increased BPV and characteristics of orthostatic hypotension in the elderly also increase the risk of cognitive decline. The current evidence does not support one category of antihypertensive drugs as superior to others for preventing dementia in elderly patients with hypertension.

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“…Similar proportions of patients were eligible for each trial when the population was limited to those with a previous diagnosis of hypertension, with the exception of OPTiMISE that had more eligible hypertensive patients (35.0%; 95% CI = 34.1-35.9%). a Data relating to the reported populations were extracted from previous publications (HYVET, SPRINT) 3,11 or obtained from the original trial data set (OPTiMISE). 18 Comparisons were made using independent samples t tests and two sample tests of proportions.…”

Section: Primary Resultsmentioning

confidence: 99%

Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis

Sheppard

Lown

Burt

et al. 2020

J American Geriatrics Society

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See related editorial by Jeff D. Williamson in this issue. BACKGROUND/OBJECTIVES: Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion and characteristics of patients eligible for hypertension trials conducted in older people. DESIGN: Cross-sectional study. SETTING: A total of 24 general practices in England. PARTICIPANTS: Anonymized electronic health record data from all individuals aged 80 and older. MEASUREMENTS: Descriptive statistics were used to define the proportion and characteristics of patients eligible for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE). A logistic regression model was constructed to estimate predictors of eligibility for each trial. RESULTS: Of 15,376 patients identified, 268 (1.7%; 95% confidence interval [CI] = 1.5-2.0%), 5,290 (34.4%; 95%CI = 33.7-35.2%), and 3,940 (25.6%; 95%CI = 24.9-26.3%) were eligible for the HYVET, SPRINT, and OPTiMISE trials, respectively. Between 5.6% and 30.7% of exclusions from each trial were due to eligibility criteria excluding those with high or uncontrolled blood pressure. Frailty (odds ratio [OR] = .44; 95%CI = .36-.54 [OPTi-MISE]), cardiovascular polypharmacy (OR = .61; 95% CI = .55-.68 [SPRINT]) and multimorbidity (OR = .72; 95%CI = .64-.82 [SPRINT]) were associated with a lower likelihood of being eligible for one or more of the trials. CONCLUSION: A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice. Caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity.

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Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial

Cited by 65 publications

References 39 publications

Promoting Successful Cognitive Aging: A Ten-Year Update

Promoting Successful Cognitive Aging: A Ten-Year Update

Effects of Antihypertensive Drugs on Cognitive Function in Elderly Patients with Hypertension: A Review

Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis

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