Intensive Blood Pressure Control Cuts Combined Mild Cognitive Impairment, Dementia Risk

Blood pressure cuff
Blood pressure cuff
In the previous SPRINT study, researchers compared an intensive BP reduction strategy (target systolic BP
The following article is part of conference coverage from the 2018 Alzheimer’s Association International Conference in Chicago, Illinois. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO — For the first time, data has demonstrated significant reductions in the risk for mild cognitive impairment (MCI) and combined MCI and dementia risk through intensive lowering of systolic blood pressure (BP). The findings from the randomized, long-term SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition IN Decreased Hypertension) study were presented at the 2018 Alzheimer’s Association International Conference, July 22-26, 2018 in Chicago, Illinois.

“This is the first randomized clinical trial to demonstrate a reduction in new cases of MCI alone and the combined risk of MCI plus all-cause dementia,” said Jeff D. Williamson, MD, MHS, professor of internal medicine and epidemiology and chief, section on gerontology and geriatric medicine at Wake Forest School of Medicine.

Chief Science Officer of the Alzheimer’s Association, Maria C. Carrillo, PhD, added, “To reduce new cases of MCI and dementia globally we must do everything we can — as professionals and individuals — to reduce blood pressure to the levels indicated in this study, which we know is beneficial to cardiovascular risk.” Dr Carrillo noted that the data are consistent with recent findings which show decreased cases of dementia in developed Western cultures as people improve certain cardiovascular disease risk factors.

In the previous SPRINT study (N=9361), researchers compared an intensive BP reduction strategy (target systolic BP <120 mmHg) vs standard BP reduction strategy (target systolic BP <140 mmHg). Older adults (aged 50 and older) with hypertension and increased cardiovascular risk (without diabetes, dementia or prior stroke diagnoses) were enrolled and completed at least 1 follow-up cognitive assessment. The data showed more intensive BP control lowered the risk for cardiovascular events by 25% and reduced the risk of overall death by 27%.

For the SPRINT MIND study, researchers evaluated whether treating to the lower BP goal reduced the risk of developing dementia and/or MCI, and whether it reduced the total volume of white matter lesions in the brain as shown by magnetic resonance imaging (MRI).

The primary outcome was incident probable dementia; secondary outcomes included MCI and a composite outcome of MCI and/or probable dementia.

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Study authors reported a statistically significant 19% reduced rate of new cases of MCI (P =.01) in the intensive-treatment group. Moreover, the combined outcome of MCI and probable all-cause dementia was found to be 15% lower (P =.02) in the intensive- vs standard-treatment group. For probable dementia alone, the risk reduction was non-significant (hazard ratio [HR] 0.83; P =.10).

In a sub-study, MRI scans revealed increases in white matter for both treatment groups but a significantly smaller increase in the intensive group vs standard group (0.28cm3 vs 0.92cm3; mean difference 0.64cm3; P =.004). Also, total brain volume decreased by 27.3cm3 in the intensive group vs 24.8cm3 in the standard group (mean difference 2.54cm3; P =.16).

Dr Williamson added that these results emphasize the need to maintain controlled blood pressure especially in adults aged >50 years. “A particular strength of SPRINT-MIND is that 30 percent of the participants were African American and 10 percent were Hispanic.”

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Williamson JD, The SPRINT Research Group. A randomized trial of intensive versus standard systolic blood pressure control and the risk of mild cognitive impairment and dementia: results from SPRINT MIND. Presented at: 2018 Alzheimer’s Association International Conference. July 22-26, 2018; Chicago, IL. Oral presentation DT-01-02.