Intensive systolic BP treatment has significant cognitive benefits in mild cognitive impairment or dementia

The secondary analysis of the SPRINT trial revealed that in a monotonic pattern patients with a higher baseline projected risk of probable dementia or amnestic mild cognitive impairment had significant absolute cognitive improvement with intensive vs conventional SBP therapy. The study results were published in the journal JAMA Network Open.  

In the SPRINT trial, intensive (systolic blood pressure [SBP] goal <120 mm Hg) vs standard (SBP goal <140 mm Hg) treatment reduced the risk of a composite outcome of mild cognitive impairment (MCI) and probable dementia, in addition to cardiovascular disease (CVD) and all-cause mortality. Detecting patient characteristics associated with the greatest magnitude of cognitive benefit from intensive vs standard SBP treatment may help prioritize patients. Intensive vs standard treatment to lower systolic blood pressure (SBP) reduces the risk of mild cognitive impairment (MCI) or dementia but the magnitude of cognitive benefit likely varies among patients. Hence researchers conducted a study to estimate the magnitude of the cognitive benefit of intensive vs standard systolic BP (SBP) treatment. 

About 9361 randomized clinical trial participants 50 years or older with high cardiovascular risk but without a history of diabetes, stroke, or dementia were followed up. The main intervention was the Systolic blood pressure treatment to an intensive (<120 mm Hg) vs standard (<140 mm Hg) target. A composite of adjudicated probable dementia or amnestic MCI was the primary outcome of the measurement. 

Key findings: 

• A total of 7918 SPRINT participants were included in the analysis. 

• There were 765 and 828 primary outcome events in the intensive treatment group and standard treatment group, respectively, over a median follow-up of 4.13 (IQR, 3.50-5.88) years.
• Older age, Medicare enrollment, and higher baseline serum creatinine level were associated with a higher risk of the primary outcome, while better baseline cognitive functioning and active employment status were associated with a lower risk of the primary outcome.
• The risk of the primary outcome by treatment aim was properly assessed based on similar projected and observed absolute risk differences.
• Across the whole range of estimated baseline risk, higher baseline risk for the main outcome was linked with the greater benefit of intensive vs standard therapy.

Thus, the researchers concluded that a higher baseline estimated risk of amnestic MCI or probable dementia was associated with greater absolute benefit from intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP treatment. 

Furthermore: Ghazi L, Shen J, Ying J, et al. Identifying Patients for Intensive Blood Pressure Treatment Based on Cognitive Benefit: A Secondary Analysis of the SPRINT Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314443. doi: 10.1001/jamanetworkopen.2023.14443