Does Aggressive Control of Blood Pressure Decrease the Risk of Cognitive Impairment? Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia- A Randomized Clinical Trial

So far, there has been no definitive treatment for dementia. There are medications that provide symptomatic relief but there has been an advance towards developing disease-modifying medications. Due to the long preclinical period of most neurodegenerative diseases, prevention as a mode of treatment seems to be an important area of exploration. The relation between high blood pressure and cognitive impairment is one important aspect. In a recent randomized controlled trial called Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study published in JAMA NETWORK, researchers from the SPRINT group embarked to ascertain if intensive blood pressure control could decrease the risk of Alzheimer disease and related dementias. This was the first trial ever to demonstrate an effectual strategy for preventing of age-related cognitive impairment as it compared the effectiveness of intensive blood pressure control (targeting a systolic blood pressure of less than 120 mm Hg) to standard blood pressure control (targeting a systolic blood pressure of less than 140 mm Hg) towards the prevention of probable dementia.

 

Almost 9,400 participants with hypertension but without stroke or diabetes were selected to take part in the study and were randomized to standard and intensive treatment. It was seen that compared to standard treatment intensive blood pressure control showed a lower but statistically non-significant risk of development of all-cause probable dementia (7.2 vs 8.6 cases per 1000 person-years), but a statistically significant reduction in the risk of developing mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years). Nevertheless, it was seen that even though intensive blood pressure control lowers the risk of neurological cognitive impairment, the group which underwent aggressive therapy had a higher degree of adverse effects, like orthostatic hypotension and acute renal failure, compared to the group with standardized treatment. Thus, it is imperative to weigh the benefits of this treatment with its adverse outcomes. In an editorial written by Kristine Yaffe M.D. (University of California, San Francisco) she stated, in respect to older patients, that “It is possible that higher perfusion pressure may be beneficial to brain health at that advanced age. This is important given that the incidence of mild cognitive impairment and dementia continues to increase in very late life and adverse events from intensive BP control also increase. Because participants were excluded from SPRINT if they had diabetes, stroke, or symptomatic heart failure, the intensive SBP control approach used in this trial cannot be generalized to older adults with those conditions.” Yet she also believed that “The connection between heart and vascular health and brain health is not appreciated by many patients and physicians, and it is essential to highlight this relationship in a public health campaign for people of all ages.”