Patients at increased risk for CVD but without diabetes, who were treated to a systolic BP target of 120 mm Hg or less had significantly less risk for mild cognitive impairment as well as white matter lesion volume vs. their counterparts treated to a systolic BP of 140 mm Hg or less according to two separate abstracts presented at the Alzheimer’s Association International Conference.
“The impact of intensive treatment of hypertension on brain health remains uncertain,” Ilya Nasrallah, MD PhD, an assistant professor of radiology at the Hospital of the University of Pennsylvania and Jeff D. Williamson, MD, program director of the Sticht Center on Aging at Wake Forest Baptist Health in North Carolina wrote in their abstracts
Williamson studied data from 8,626 participants of the Systolic Blood Pressure Intervention Trial, or SPRINT (mean age, 67.9 years). He found that after a median of 3.26 years, participants treated to a systolic BP of 120 mm Hg or less had a significantly lower rate of adjudicated incident mild cognitive impairment (HR = 0.81; 95% CI, 0.7-0.95) and a nonsignificant reduction in probable dementia (HR = 0.83; 95% CI, 0.67-1.04) vs. those treated to a systolic BP of 140 mm Hg or less.
Williamson also discovered the combined outcome of mild cognitive impairment plus probable all-cause dementia was significantly lower (HR = 0.85; 95% CI, 0.74-0.97) in the group treated to a systolic BP of 120 mm Hg or less.
Nasrallah analyzed 454 participants of the same trial recruited for a brain MRI. He found that after a median of 3.98 years after randomization, white mass lesion volume increased by 0.28 cm3 (95% CI, –0.03 to 0.58) in those treated to a systolic BP of 120 mm Hg or less vs. 0.92 cm3 (95% CI, 0.59-1.24) among those treated a systolic BP of 140 mm Hg or less (mean difference = 0.64 cm3; P = .004). In addition, total brain volume decreased by 27.3 cm3 (95% CI, 24.8-29.8) in those treated to a systolic BP of 120 mm Hg or less vs. 24.8 cm3 (95% CI, 22-27.5) in those treated to a systolic BP of 140 mm Hg or less. Sensitivity analyses did not significantly impact the findings, Nasrallah added. – by Janel Miller
Nasrallah I, et al. A randomized trial of intensive versus standard systolic blood pressure control on brain structure: Results from Sprint Mind MRI.
Williamson J, et al. Randomized trial of intensive versus standard systolic blood pressure control and the risk of mild cognitive impairment and dementia: Results from Sprint Mind.
Both presented at: Alzheimer’s Association International Conference; July 22-26, 2018; Chicago.
Healio Family Medicine was unable to determine the authors’ relevant financial disclosures prior to publication.