Intensive Hypertension Control Reduces Mild Cognitive Impairment and Dementia

Maria C. Carrillo, PhD

Preliminary results from the Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study suggest that intensive lowering of systolic blood pressure significantly reduces the risk of mild cognitive impairment (MCI) and dementia in combination with MCI.

“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.

SPRINT MIND was an extension of the SPRINT trial that compared the effect of reducing systolic blood pressure below 140 mm Hg or 120 mm Hg on cardiovascular outcomes. Stunning results led researchers to end the study about a year early and contributed to the 2017 American Heart Association (AHA) and American College of Cardiology’s (ACC) guidelines on hypertension.

Williamson reported the SPRINT MIND results at the Alzheimer’s Association International Conference (AAIC) 2018 in Chicago.

The study included 9361 adults age 50 or older (mean age 67.9 years) with hypertension and an increased cardiovascular risk, based on the Framingham risk score, but without diagnosed diabetes, dementia, or prior stroke. A large majority of patients (8626, 92.1%) completed at least 1 follow-up cognitive assessment.

Participants were randomized to either an intensive strategy arm with a systolic blood pressure goal of <120 mm Hg or a standard care strategy arm with a systolic blood pressure goal of <140 mm Hg (135 to 139 mm Hg).

Researchers found that the intensive blood pressure treatment arm had a statistically significant 19% lower rate of new cases of MCI (p = 0.01). The combined outcome of MCI plus probable all-cause dementia was 15% lower (p = 0.02) in the intensive group compared to the standard treatment group.

The reduction in dementia alone was not significant (HR = 0.83, p = 0.10).

“This study shows more conclusively than ever before that there are things you can do—especially regarding cardiovascular disease risk factors&mdash;to reduce your risk of MCI and dementia,” said Maria C. Carrillo, PhD, Alzheimer’s Association Chief Science Officer. “To reduce new cases of MCI and dementia globally we must do everything we can&mdash;as professionals and individuals&mdash;to reduce blood pressure to the levels indicated in this study, which we know is beneficial to cardiovascular risk.”

According to the New England Journal of Medicine serious adverse events occurred in 1793 patients (38.3%) the intensive treatment group and in 1736 patients (37.1%) in the standard treatment group (HR with intensive treatment, 1.04; p = 0.25). Hypotension, syncope, electrolyte abnormalities, and acute kidney injury or acute renal failure occurred more often in the intensive treatment arm.

Serious adverse events determined to be possibly or definitely related to the intervention occurred in 220 patients (4.7%) in the intensive treatment arm and in 118 patients (2.5%) in the standard treatment arm.

“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&mdash;healthier. These new results for maintaining cognitive health provide another strong rationale for starting and maintaining healthy lifestyle changes in mid-life,” Williamson added.