Winston-Salem, NC—Aggressive lowering of systolic blood pressure appears to have benefits beyond those previously documented, a new study finds.

A presentation at the recent Alzheimer’s Association International Conference (AAIC) 2018 in Chicago reports that new research results from the federally funded SPRINT MIND study indicate that intensive hypertension treatment also significantly reduces mild cognitive impairment (MCI) and the combination of MCI and dementia.

“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,” explained presenter 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.

Participants were adults with increased risk for cardiovascular disease but without diabetes. They were treated to a systolic blood pressure (BP) target of less than 120 mmHg, versus a target of less than 140 mmHg.

Results were from a substudy of the SPRINT trial, which randomized patients to either a standard group, with a target of less than 140 mm Hg, or an intensive-treatment group, with a target of less than 120 mm Hg. SPRINT MIND focused on 9,361 hypertensive older adults with increased cardiovascular risk but without diagnosed diabetes, dementia, or stroke.

After a year, mean systolic BP was 121.4 mmHg in the intensive-treatment group and 136.2 mmHg in the standard group, and researchers report a “significantly lower rate” of adjudicated incident MCI and a “non-significant reduction” in the primary outcome of probable dementia. In addition, the secondary outcomes of a combined outcome of MCI plus probable dementia were found to be significantly lower in the intensive versus standard treatment group.

In SPRINT MIND, researchers documented a statistically significant 19% lower rate of new cases of MCI in the intensive blood-pressure treatment group. At the same time, the combined outcome of MCI plus probable all-cause dementia was 15% lower in the intensive versus the standard treatment group. The reduction in probable dementia alone was nonsignificant, with a hazard ratio of 0.83.

The presentation noted that 220 participants in the intensive-treatment group (4.7%) and 118 participants in the standard-treatment group (2.5%) had serious adverse events that were classified as possibly or definitely related to the intervention, for a hazard ratio of 1.88.

“These results support the need to maintain well-controlled blood pressure, especially for persons over the age of 50,” Williamson pointed out. “A particular strength of SPRINT-MIND is that 30 percent of the participants were African American and 10 percent were Hispanic.”

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