Highlights from

AAN 2019

American Academy of Neurology annual meeting

Philadelphia, USA 4-10 May 2019

Tight blood pressure control lowers risk of mild cognitive impairment

Treating adults with hypertension to a systolic blood pressure goal of less than 120 mmHg compared with a goal of less than 140 mmHg did not reduce the risk of probable dementia, but it did lower the risk of mild cognitive impairment (MCI).

In the original SPRINT trial, among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mmHg, as compared with less than 140 mmHg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause [1]. The trial was stopped early for benefit on its primary outcome.

SPRINT MIND consequently evaluated the effect of intensive blood pressure control on risk of dementia. Geriatrist Dr Jeff Williamson (Wake Forest Baptist Medical Center, Winston-Salem, USA) presented the results. Participants were adults aged 50 years or older with hypertension but without diabetes or history of stroke. They were randomised to a systolic blood pressure goal of <120 mmHg (intensive treatment; n=4,678) or <140 mmHg (standard treatment; n=4,683).

During a median follow-up of 5.11 years, the primary cognitive outcome of adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (HR 0.83). Intensive blood pressure control significantly reduced the risk of MCI (HR 0.81), as well as the combined rate of MCI or probable dementia (HR 0.85). The study's early termination and fewer than expected cases of dementia may have rendered the study underpowered to show an effect on dementia. The main MRI results, which had as yet not been published, of intensive vs standard blood pressure control were:

  • transformed white matter lesion volume: 0.15 vs 0.28 cm3 (P<0.001);
  • total brain volume change: -30.6 vs -26.9 mm3 (P=0.006).

In conclusion, Dr Williamson said: “SPRINT MIND is the first randomised control trial intervention to show a reduction in the risk of MCI, without evidence that intensive blood pressure control harms cognition. This study demonstrates that a diverse population can be recruited, randomised, and assessed in follow-up for cognition over 5 years with acceptable assessment protocol adherence.”

  1. Wright JT Jr, et al. N Engl J Med. 2015;373(22):2103-16.
  2. Williamson JD, et al. JAMA. 2019;321(6):553-561.

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