Tight blood pressure control lowers risk of mild cognitive impairment

Treating adults with hypertension to a systolic blood pressure goal of <120 mmHg compared with <140 mmHg lowered the risk of mild cognitive impairment (MCI), according to findings of the SPRINT MIND trial [1].

In the original SPRINT trial, targeting a systolic blood pressure of <120 mmHg resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause among patients at high risk for cardiovascular events without diabetes [2]. 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 aged 50 years or older with hypertension but without diabetes or a 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 5.1 years, the primary cognitive outcome of adjudicated probable dementia occurred in 149 and 176 participants in the intensive and standard treatment group, respectively (HR 0.83). Dr Williamson speculated the study may have been underpowered to show an effect on dementia. Intensive blood pressure control did significantly reduce the risk of MCI (HR 0.81), as well as the combined rate of MCI or probable dementia (HR 0.85). The main MRI results, which had not yet been published, of intensive versus standard blood pressure control were as follows:

• white matter lesion volume: 0.92 vs 1.45 cm³;
• 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).

Dr Williamson concluded: “SPRINT MIND is the first randomised controlled 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. Williamson JD, et al. JAMA. 2019;321(6):553-61.
2. Wright JT Jr, et al. N Engl J Med. 2015;373(22):2103-16.



Posted on 30 July, 201915 March, 2021