Aggressive Treatment of Hypertension Promotes Healthy Brains and Hearts

Sunday, July 29, 2018

Aggressive lowering of systolic blood pressure (BP) reduces the risk of mild cognitive impairment (MCI) and combined MCI and dementia. In the SPRINT trial (NCT01206062), 2 strategies for managing high BP were compared in adults over age 50. The first was an intensive strategy with a goal of subjects achieving systolic BP of <120 mmHg, and the second a standard care strategy with a goal of achieving systolic BP of <140 mmHg. As reported previously, this demonstrated that the more aggressive goal of achieving <120 mmHg systolic BP reduces risk of cardiovascular morbidity and mortality (N Engl J Med. 2015;373:2103-2116). In the SPRINT MIND portion of the trial, the cognitive scores of subjects were examined as a secondary measure to determine if the lower blood pressure target correlated with cognitive scores and the present of MCI or dementia or both. Total volume of white matter lesions in the brain as shown by MRI was also measured.

Subjects included 9,361 adults with high BP who had a mean age of 67.9 and increased cardiovascular risk, based on the Framingham risk score, but had not been diagnosed with diabetes, dementia or prior stroke. Cognitive assessments were performed in 92.1% (8,626) of subjects assessing for incident probable dementia. Subjects were also assessed for mild cognitive impairment and a composite outcome of MCI and/or probable dementia. Assessments were adjudicated by a blinded expert panel.

After 1 year of treatment, the mean systolic BP in the intensive treatment group was 121.4 mmHg and 136.2 mmHg in the standard treatment group. Cognitive assessments were performed over a 4-year period. Subjects in the intensive treatment group had a 19% lower rate of new case of MCI (P= .01) compared with those in the standard treatment group. The combined outcome of MCI plus probable all-cause dementia was 15% lower (P = .02) in the intensive versus standard treatment group.

There was no significant difference in the rate of overall adverse events between the 2 treatment groups (P = .25), although hypotension, syncope, electrolyte abnormalities, and acute kidney injury or acute renal failure, but not injurious falls or bradycardia, occurred more frequently in the intensive-treatment group than in the standard-treatment group. Orthostatic hypotension was significantly less common in the intensive-treatment group.

Lead investigator Jeff Williamson, MD, MHS stated, “These results support the need to maintain well-controlled blood pressure, especially for persons over the age of 50. This is something doctors and the majority of their community-dwelling patients with elevated blood pressure should be doing now to keep their hearts— and brains—healthier. These new results for maintaining cognitive health provide another strong rationale for starting and maintaining healthy lifestyle changes in mid-life,” Williamson added.

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