Lifestyle modification and cognitive function among individuals with resistant hypertension: cognitive outcomes from the TRIUMPH trial

Abstract

Background: Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function. Methods: Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitationbased lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure.Results: Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI ¼ 36 kg/m 2 (SD ¼ 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [t-scores pretreatment ¼ 48.9 (48, 50) vs. posttreatment ¼ 50.0 (49, 51), P < 0.001]. Postintervention Executive Function/ Learning composite performance was higher for participants in C-LIFE compared to SEPA (d ¼ 0.37, P ¼ 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively (P ¼ 0.026 and P ¼ 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD

Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension

“…The methodology for the present report has been previously published. 6 , 7 Briefly, the TRIUMPH study was a randomized clinical trial (RCT) designed to evaluate whether intensive lifestyle modification could reduce BP and improve CVD biomarker outcomes among 140 individuals with RH relative to an education and physician advice control condition. 6 Details of the primary trial results and neurocognitive outcomes have been reported previously (NCT03001427 and NCT03001427).…”

“… 6 Details of the primary trial results and neurocognitive outcomes have been reported previously (NCT03001427 and NCT03001427). 6 , 7 One hundred forty patients with RH were randomized with 2:1 allocation to either a 4‐month Center‐based Lifestyle intervention (C‐LIFE) or Standardized Education and Physician Advice (SEPA).…”

“…Neurocognitive function was assessed by a battery of standard neurocognitive tests, which are detailed in the primary paper. 7 The primary endpoint of the TRIUMPH cognitive study was Executive Function and Learning, with Memory and Processing Speed serving as secondary outcomes. Participants were also screened for dementia using the Montreal Cognitive Assessment test (MOCA).…”

“…The TRIUMPH clinical trial 6 demonstrated that a comprehensive exercise and dietary program can improve blood pressure, weight, and CVD biomarkers, 6 as well as improving neurocognitive function. 7 Emerging evidence suggests that individual differences in CVD risk factors and background characteristics may moderate improvements neurocognition, particularly in the domain of executive function. 7 , 8 Despite these reported individual differences and the potentially integral role of inflammation, to our knowledge no studies have examined inflammation as a potential moderator of improved cognitive function following lifestyle modification.…”

“… 7 Emerging evidence suggests that individual differences in CVD risk factors and background characteristics may moderate improvements neurocognition, particularly in the domain of executive function. 7 , 8 Despite these reported individual differences and the potentially integral role of inflammation, to our knowledge no studies have examined inflammation as a potential moderator of improved cognitive function following lifestyle modification. Therefore, this brief report aimed to investigate the potential influence of individual differences in pre‐treatment inflammatory profiles on changes in cognition following lifestyle modification among RH participants in the TRIUMPH clinical trial.…”