1. Intensive treatment of blood pressure resulted in small but statistically significant greater decline in hippocampal volume compared to standard treatment.
2. No significant differences between treatment groups in other Alzheimer’s disease biomarkers.
Evidence Rating Level: 2 (Good)
Several randomized clinical trials have suggested that control of hypertension reduces future risk of cognitive impairment and dementia. However, meta-analyses of these trials have not demonstrated how Alzheimer’s disease (AD) pathology is affected by the treatment of hypertension. This secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT MIND) randomized trial aimed to investigate the association of intensive blood pressure control on AD biomarkers, such as hippocampal volume, regional atrophy, posterior cerebral blood flow, and mean fractional anisotropy in the cingulum bundle. Participants were 50 years of age or older with documented hypertension and without a history of stroke or diabetes. A total of 673 participants had baseline MRI (M [SD] age = 67.3 [8.2] years, 40.3% female) and 454 completed the follow-up MRI (median (IQR) time = 3.98 [3.7 to 4.1] years) after randomization to either a systolic blood pressure goal of ≥120 mm Hg (intensive treatment, n = 356) or ≤140 mm Hg (standard treatment, n = 317). The intensive treatment group demonstrated small but statistically significant greater decrease in hippocampal volume (difference -0.06cm3, 95% CI -0.08 to -0.04) compared to the standard treatment group (difference, -0.02cm3, 95% CI -0.05 to -0.003, p = 0.03). Interestingly, no significant differences were found between treatment groups in measures of cerebral blood flow, AD regional atrophy, or mean fractional anisotropy. Overall, this study suggests that intensive control of blood pressure results in greater reductions of hippocampal volume and, thus, total brain volume, compared to standard treatment. However, these differences were small and not found in the context of other AD biomarkers.
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