Key result
Intensive BP lowering fails to reduce probable dementia over standard control despite lowering cognitive impairment.
Why the study?
Following the SPRINT-MIND trial demonstrating reduced cognitive impairment with intensive blood-pressure lowering, key questions and recommendations for clinical practice and future clinical trials needed to be addressed.
Does intensive blood pressure lowering reduce the risk of probable dementia in older adults with hypertension and increased cardiovascular risk?
Does intensive blood pressure lowering reduce the risk of probable dementia in older adults with hypertension and increased cardiovascular risk?
Intensive blood pressure lowering reduces the risk of mild cognitive impairment and may be a cost-effective strategy to preserve cognitive health in aging populations, despite not reaching significance for probable dementia due to early trial termination.
A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.
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Elahi et al. (2023) conducted a review in Hypertension with increased cardiovascular risk (n=9,361). Intensive blood pressure lowering vs. Standard blood pressure lowering (target SBP < 140 mm Hg) was evaluated on Probable dementia (HR 0.83, 95% CI 0.67-1.04, p=0.10). Intensive blood pressure lowering to a target systolic blood pressure <120 mm Hg did not significantly reduce the risk of probable dementia compared to standard treatment (HR 0.83, p=0.10), but significantly reduced mild cognitive impairment.
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