Philadelphia, PA—Does intensively controlling blood pressure (BP) slow the accumulation of white-matter lesions in the brain more than standard treatment does?

Results of a nationwide study using magnetic resonance imaging (MRI) to scan the brains of hundreds of participants in the National Institutes of Health’s Systolic Blood Pressure Intervention Trial (SPRINT) found that to be the case.

The report in JAMA bolstered another study from the same research group indicating that intensive treatment significantly lowered the risk of developing mild cognitive impairment.

Past research has suggested that patients with hypertension have a greater chance of accumulating white-matter lesions and also of experiencing cognitive disorders and dementia later in life. The observations were tested in a randomized clinical trial, called SPRINT Memory and Cognition in Decreased Hypertension (MIND), which looked at whether controlling BP levels could prevent or slow white-matter lesion progression and aging-related brain disorders.

The substudy involved 449 hypertensive patients who underwent longitudinal brain MRI. The randomized, controlled trial determined that intensive BP management to a target systolic blood pressure (SBP) of less than 120 mmHg, versus less than 140 mmHg, was associated with a smaller increase in white-matter lesion volume (0.92 cm3 vs. 1.45 cm3).

“More intensive blood pressure management was associated with less progression of cerebral small vessel ischemic disease, although the difference was small,” the study pointed out.

The original SPRINT was a multicenter, randomized clinical trial of hypertensive adults aged 50 years or older without a history of diabetes or stroke at 27 sites in the United States. The overall trial was stopped early in 2015 because of demonstrated benefit for its primary outcome—a composite of cardiovascular events—as well as all-cause mortality.

In the subset study, the primary outcome was defined as change in total white-matter lesion volume from baseline. Change in total brain volume was a secondary outcome.

Of the 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years.

Results showed that, in the intensive-treatment group, based on a robust linear mixed model, mean white-matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 [95% CI, 0.69 to 1.14]) versus an increase from 4.40 to 5.85 cm3(difference, 1.45 cm3 [95% CI, 1.21 to 1.70]) in the standard-treatment group (between-group difference in change, -0.54 cm3 [95% CI, -0.87 to -0.20]).

At the same time, mean total brain volume decreased from 1,134.5 to 1,104.0 cm3 (difference, -30.6 cm3 [95% CI, -32.3 to -28.8]) in the intensive-treatment group versus a decrease from 1,134.0 to 1,107.1 cm3 (difference, -26.9 cm3 [95% CI, 24.8 to 28.8]) in the standard-treatment group (between-group difference in change, -3.7 cm3 [95% CI, -6.3 to -1.1]).

“Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small,” the study authors concluded.

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