Cognitive protection greater with intensive vs standard SBP lowering for high-risk individuals

For individuals with increased projected risk of probable dementia or amnestic mild cognitive impairment (MCI) who are prescribed antihypertensive treatment, intensive systolic blood pressure (SBP) lowering confers greater cognitive benefits than standard treatment, according to a secondary analysis of the SPRINT trial.

The analysis included 7,918 SPRINT participants who were at least 50 years of age and had high cardiovascular risk but without a history of diabetes, stroke, or dementia. Of these, 3,989 were in the intensive treatment group (<120 mm Hg target, mean age 67.9 years, 64.4 percent men, 30.4 percent non-Hispanic Black) and 3,929 were in the standard treatment group (<140 mm Hg target, mean age 67.9 years, 65.4 percent men, 31.8 percent non-Hispanic Black).

Over a median follow-up of 4.13 years, the primary endpoint of a composite of adjudicated probable dementia or amnestic MCI was documented in 765 participants in the intensive treatment group and 828 participants in the standard treatment group.

Factors associated with an increased risk of the primary endpoint included older age (hazard ratio [HR] per 1 SD, 1.87, 95 percent confidence interval [CI], 1.78–1.96), Medicare enrollment (HR per 1 SD, 1.42, 95 percent CI, 1.35–1.49), and higher baseline serum creatinine level (HR per 1 SD, 1.24, 95 percent CI, 1.19–1.29).

On the other hand, factors associated with a protective benefit were better baseline cognitive functioning (HR per 1 SD, 0.43, 95 percent CI, 0.41–0.44) and active employment status (HR per 1 SD, 0.44, 95 percent CI, 0.42–0.46).

Notably, a higher baseline risk for the primary outcome was associated with greater benefit (ie, larger absolute reduction of probable dementia or amnestic MCI) with intensive vs standard treatment across the full range of estimated baseline risk.