#VisualAbstract: Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia

1. In this randomized controlled trial, intensive blood pressure lowering in elderly patients reduced the risk of developing Mild Cognitive Impairment (MCI) compared to standard blood pressure lowering.

2. While there was no difference in the risk of dementia between groups, the trial was terminated early due to observed cardiovascular benefits seen in the intensive blood pressure lowering group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Vascular damage caused by high blood pressure has been shown to increase the risk and severity of dementia. However, while excessively high blood pressures are known to influence pathology, it is unclear if intensive blood pressure lowering has a beneficial or detrimental effect on dementia risk. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to evaluate the effect of lowering systolic blood pressure to less than 120mmHg on cardiovascular, renal, and cognitive outcomes. In this randomized controlled trial, elderly patients were randomized to receive either intensive blood pressure lowering (systolic blood pressure goal <120 mmHg) or standard blood pressure lowering (<140 mmHg) therapies. Though intensive blood pressure lowering did not result in a reduction in dementia diagnoses, it did reduce the risk of Mild Cognitive Impairment (MCI).

It has been hypothesized that intensive blood pressure lowering may increase the risk of dementia, this study suggests that it is unlikely to change dementia risk but may reduce the pre-dementia state of MCI. Though the study was well-designed and had a relatively large sample size, there was a drop-off in follow-up rates after about four years, and it is unclear if reduced conversion to dementia would be apparent at later time points. Finally, the trial was terminated early due to the cardiovascular benefit of better blood pressure control, which perhaps limited the observed cognitive differences.

Click to read the study in JAMA

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