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Intensive vs. Standard Blood Pressure Control and Dementia
Study Questions:
Does intensive blood pressure (BP) control lower risk for dementia?
Methods:
Data from the SPRINT (Systolic Blood Pressure Intervention Trial) study, which was designed to test the effect of more intensive BP control, were used for the present analysis. Cognitive function was a secondary endpoint of the original trial, which was stopped early for benefit of its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Cognitive outcomes were followed through July 2018. Adults ages ≥50 years with hypertension (HTN) but without diabetes or prior stroke were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg defined as intensive treatment, or to standard therapy defined as an SBP goal of <140 mm Hg. The primary outcome for the present study 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:
A total of 9,361 participants were randomized to intensive treatment (n = 4,678) or standard treatment (n = 4,683). Mean age was 67.9 years and 3,332 were women. Of those enrolled, 8,563 (91.5%) completed ≥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 versus 176 in the standard treatment group (7.2 vs. 8.6 cases per 1,000 person-years; hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.67-1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs. 18.3 cases per 1,000 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 1,000 person-years; HR, 0.85; 95% CI, 0.74-0.97).
Conclusions:
The authors concluded that among ambulatory adults with HTN, treating to an SBP goal of <120 mm Hg compared with a <140 mm Hg goal 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 endpoint.
Perspective:
Although these results do not demonstrate that lowering SBP to <120 mm Hg is associated with reduced risk for probable dementia, there did appear to be a lower risk for mild cognitive impairment or the combination of mild cognitive impairment or probable dementia. As the authors note, early termination of the study may have reduced the ability to detect an endpoint such as dementia. It may be hypothesized that more years of BP control <120 mm Hg would be associated with less cognitive decline leading to less risk for dementia over time. It stands to reason that optimizing cardiovascular risk factors throughout a lifetime leads to good cognitive health.
Keywords: Blood Pressure, Blood Pressure Determination, Cognition, Dementia, Metabolic Syndrome, Cognitive Dysfunction, Hypertension, Primary Prevention, Risk Factors
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