Article Impact Level: HIGH Data Quality: STRONG Summary of Neurology, 104(3), e213334. https://doi.org/10.1212/WNL.0000000000213334 Dr. David M. Reboussin et al.
Points
- A secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) examined the effects of intensive (<120 mm Hg) vs. standard (<140 mm Hg) systolic blood pressure (SBP) lowering on cognitive outcomes in hypertensive individuals aged 50+ with increased cardiovascular risk over a median follow-up of 7 years.
- Intensive SBP lowering was associated with a reduced risk of mild cognitive impairment (MCI) (HR 0.87; 95% CI, 0.76–1.00) and the composite outcome of MCI or probable dementia (HR 0.89; 95% CI, 0.79–0.99).
- While the incidence of probable dementia was lower in the intensive treatment group (8.5 vs. 10.2 cases per 1,000 person-years; HR 0.86; 95% CI, 0.72–1.02), the results for dementia alone were inconclusive due to fewer cases than anticipated.
- Of the 9,361 randomized participants, 4,232 (59%) were assessed for cognitive status through in-person and telephone follow-ups.
- Intensive SBP lowering may help prevent cognitive decline, particularly MCI and combined cognitive outcomes. It provides Class II evidence of its potential benefits for cognitive health in individuals with hypertension and cardiovascular risk.
Summary
This study is a secondary analysis of the Systolic Blood Pressure Intervention Trial, which aimed to assess the long-term effects of intensive vs. standard systolic blood pressure (SBP) lowering on cognitive impairment in individuals aged 50 and older with hypertension and increased cardiovascular risk. Participants were randomly assigned to an SBP goal of <120 mm Hg (intensive treatment) or <140 mm Hg (standard treatment) and followed for a median of 7 years. Cognitive status was assessed both in-person and through telephone follow-ups. 9,361 patients were randomized, with 7,221 (77%) eligible for re-contact, and cognitive status was ascertained for 4,232 participants (59%).
The results showed that intensive SBP treatment was associated with a lower incidence of probable dementia, with 248 cases in the intensive group (8.5 per 1,000 person-years) and 293 in the standard treatment group (10.2 per 1,000 person-years), resulting in a hazard ratio (HR) of 0.86 (95% CI, 0.72–1.02). Additionally, the risk of mild cognitive impairment (MCI) was lower in the intensive treatment group (HR, 0.87; 95% CI, 0.76–1.00), as well as the composite outcome of MCI or probable dementia (HR, 0.89; 95% CI, 0.79–0.99). However, the study did not meet its target for new cases of probable dementia, with only 216 cases observed, making the results for probable dementia alone inconclusive.
In conclusion, intensive SBP lowering to a target of <120 mm Hg reduced the risk of MCI and cognitive impairment, including both MCI and probable dementia, but did not significantly reduce the incidence of probable dementia alone. This study provides Class II evidence that intensive SBP treatment may help prevent cognitive decline in individuals with hypertension and increased cardiovascular risk.
Link to the article: https://www.neurology.org/doi/10.1212/WNL.0000000000213334
References Reboussin, D. M., Gaussoin, S. A., Pajewski, N. M., Jaeger, B. C., Sachs, B., Rapp, S. R., Supiano, M. A., Cleveland, M. L., Hunter, V., Demons, J. L., Ogrocki, P. K., Lerner, A. J., Chelune, G. J., Wadley, V. G., Scales, M. L., Woolard, N. F., Perdue, L. H., Callahan, K. E., & Williamson, J. D. (2025). Long-term effect of intensive vs standard blood pressure control on mild cognitive impairment and probable dementia in sprint. Neurology, 104(3), e213334. https://doi.org/10.1212/WNL.0000000000213334
