The following is from Systolic Blood Pressure Intervention Trial (SPRINT) OVERVIEW from the NIH National Heart, Lung, and Blood Institute (Last Updated: November 14, 2017):
The SPRINT Memory and Cognition in Decreased Hypertension (MIND) study is comparing the two blood pressure targets for their impact on cognitive function and dementia. Researchers conducted dementia testing in all SPRINT participants and additional cognitive function testing and magnetic resonance imaging (MRI) scans of the brain in a subset of participants. Researchers continue to analyze the results of this testing and are conducting one additional visit with SPRINT participants to collect final cognitive assessments. These consolidated cognitive findings are expected in 2019.
It is expected that The SPRINT-MIND study will demonstrate whether strict hypertension treatment lowers the risk of decreased cognition and dementia.
No randomized trial of BP lowering has demonstrated an adverse impact on dementia incidence or cognitive function. [p 144 of Resource (1)]
Because of the above, I believe it makes sense to vigorously treat hypertension especially since the main SPRINT trial has shown awesome benefit in many other health domains.
This is the ninth of nine posts extracting the highlights of the new 2017 hypertension guidelines (Resource 2). The nine posts are:
- 1 – Definition And Measurement Of High Blood Pressure – Extracts From The New 2017 Hypertension Guidelines. Posted on Nov 23, 2017
- 2 – Evaluation And Causes Of Hypertension – Extracts From The New 2017 Hypertension Guidelines. Posted on November 24, 2017
- 3 – Treatment Of Hypertension – Extracts From The New 2017 Hypertension Guidelines. Posted on November 24, 2017
- 4 – Treatment of Hypertension In Patients With Comorbidities – Extracts From The New 2017 Hypertension Guidelines. Posted on November 25, 2017
- 5 – Treatment of Hypertension In Special Patient Groups – Extracts From The New 2017 Hypertension Guidelines. Posted on November 26, 2017
- 6 – Treatment Of Resistant Hypertension – Extracts From The New 2017 Hypertension Guidelines. Posted on November 26, 2017
- 7 – Treatment Of Hypertensive Emergencies – Extracts From The New 2017 Hypertension Guidelines. Posted on November 26, 2017
- 8 – Patients Undergoing Surgical Procedures – Extracts From The New 2017 Hypertension Guidelines. Posted on November 26, 2017 – Pending
- 9 – Treatment of Hypertension To Prevent Cognitive Decline And Dementia – Extracts From The New 2017 Hypertension Guidelines. Posted on November 26, 2017
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for
the Prevention, Detection, Evaluation, and Management of High Blood Pressure in
Adults [PubMed Citation] [Full Text PDF]. Hypertension. 2017 Nov 13. pii: HYP.0000000000000065. doi: 10.1161/HYP.0000000000000065. Epub ahead of print
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [PubMed Citation] [Full Text PDF].
What follows is from Resource 1 above:
11.3. Cognitive Decline and Dementia
Recommendation For The Prevention of Cognitive Decline and Dementia
- In adults with hypertension, BP lowering is reasonable to prevent cognitive decline and dementia. (1 – 6)
Dementia is a leading cause of mortality and placement into nursing homes and assisted living facilities, affecting >46 million individuals globally and 5 million persons in the United States, a number that is expected to double by 2050 (7). A 5-year delay in onset of dementia would likely decrease the number of cases of incident dementia by about 50% after several decades (8). Vascular disease and its risk factors are implicated in a large proportion of patients with dementia, including those with Alzheimer’s dementia (9-11). Hypertension is also the primary risk factor for small-vessel ischemic disease and cortical white matter abnormalities (12-15). Most observational studies have suggested that better control of SBP may reduce Alzheimer’s disease and other dementias, and the evidence is stronger for BP lowering in middle age than in the elderly (9, 16). Clinical trials with dementia assessment have evaluated all-cause dementia but not Alzheimer’s disease specifically. However, all of these trials have methodological issues, such as low power, insufficient follow-up length, and inadequately designed dementia assessment batteries.
Recommendation-Specific Supportive Text
1. Five clinical trials of BP lowering have included assessment for incident dementia. Of these 5 trials, 4 demonstrated a reduction in dementia incidence, with 2 of these 4 demonstrating statistical significance (746- 751). SYST-EUR (Systolic Hypertension in Europe) (17) and PROGRESS (Perindopril Protection Against Recurrent Stroke) (18) both showed statistically significant reductions in incident dementia. SYST-EUR achieved an SBP of 152 mm Hg in the treatment arm (8.3 mm Hg lower than placebo arm) during its blinded phase and an SBP of 149 mm Hg (7.0 mm Hg lower than comparison group) during its open-label follow-up phase (2, 3). PROGRESS achieved an SBP of 138 mm Hg in the treatment group (9 mm Hg lower than the placebo group) and demonstrated dementia prevention in patients with a recent stroke (5). The trial showing no benefit in the direction of dementia reduction achieved an SBP reduction of only 3.2 mm Hg, whereas the
other 4 trials achieved SBP reductions of 7 to 15 mm Hg (746-751). When the rate of cognitive decline (not
dementia) has been a trial outcome, 7 clinical trials of BP-lowering therapy have been completed, and 2 of
these have shown benefit (4-6, 19-22). No randomized trial of BP lowering has demonstrated an adverse
impact on dementia incidence or cognitive function. However, the anticipated results from SPRINT, the first
adequately powered RCT to test whether intensive BP control reduces dementia, may help clarify this issue in
the near future.