Intensive Blood Pressure Treatment Could Protect Against Cognitive Decline

Article

Data from the SPRINT MIND trial suggests intensive blood pressuring-lowering was associated with slower increases in white matter lesions and improved cerebral blood flow.

Mohamad Habes, PhD | Credit: Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases

Mohamad Habes, PhD
Credit: Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases

A new post hoc secondary analysis of the landmark SPRINT MIND trial provides evidence suggesting intensive blood pressure treatment during midlife could help preserve cognitive function as a person ages.

Results of the analysis, which assessed differences in white matter concentrations in different regions of the brain, determined patients randomized to intensive blood pressure treatment experienced a slower increase of white matter lesions and improved cerebral blood flow in areas vulnerable to hypertension when compared to their counterparts who received standard blood pressure treatment.

“Our study demonstrates that lowering systolic blood pressure to below 120 mm Hg is more effective in preserving brain health compared to standard treatment goals,” said corresponding author Mohamad Habes, PhD, assistant professor of radiology and director of the neuroimaging core at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases.2

The prevalence of hypertension has placed a significant burden on health systems for decades. During this same time, the effects of hypertension on other aspects of health, beyond cardiovascular risk, have begun to come to light, including the potential impact on cognitive health.

Launched in 2010, the SPRINT trial was designed with the intent of comparing the effects of an intensive blood pressure lowering strategy relative to a standard blood pressure lowering strategy. Results of the 9361-patient trial indicated an intensive blood pressure treatment approach was associated with a 25% relative reduction in risk of the primary composite outcome of myocardial infarction, acute coronary syndrome, stroke, congestive heart failure, or cardiovascular death relative to standard treatment approach.3

Of the 9361 original participants in the SPRINT trial, a total of 2921 were selected for a post hoc subsidy of cognitive outcomes. From this group, 1267 were invited to participate in the post hoc SPRINT MIND subsidy to undergo brain MRI scanning at baseline and 48-month follow-up. A total of 597 participants were excluded from the current post hoc analysis of SPRINT MIND, leaving a cohort of 670 patients. The primary outcomes of interest for the current study were regional changes in white matter lesions, fractional anisotropy, mean diffusivity, and cerebral blood flow.1

Of the 670 patients included in the current analysis, 355 received intensive blood pressure treatment and 315 received standard blood pressure treatment. The intensive blood pressure group had a mean age of 67.7 (SD, 8.00) years and 56.3% were men. The standard blood pressure treatment group had a mean age of 67.0 (SD, 8.4) years and 63.2% were men.1

Smaller mean increases were seen in intensive treatment than with standard blood pressure treatment. Specific deep white matter regions experiencing smaller mean increases with intensive blood pressure treatment were the left anterior corona radiata (intensive treatment, 30.3 mm3 [95% CI, 16.0-44.5 mm3]; standard treatment, 80.5 mm3 [95% CI, 53.8-107.2 mm3]), left tapetum (intensive treatment, 11.8 mm3 [95% CI, 4.4-19.2 mm3]; standard treatment, 27.2 mm3 [95% CI, 19.4-35.0 mm3]), left superior fronto-occipital fasciculus (intensive treatment, 3.2 mm3 [95% CI, 0.7-5.8 mm3]; standard treatment, 9.4 mm3 [95% CI, 5.5-13.4 mm3]), left posterior corona radiata (intensive treatment, 26.0 mm3 [95% CI, 12.9-39.1 mm3]; standard treatment, 52.3 mm3 [95% CI, 34.8-69.8 mm3]), left splenium of the corpus callosum (intensive treatment, 45.4 mm3 [95% CI, 25.1-65.7 mm3]; standard treatment, 83.0 mm3 [95% CI, 58.7-107.2 mm3]), left posterior thalamic radiation (intensive treatment, 53.0 mm3 [95% CI, 29.8-76.2 mm3]; standard treatment, 106.9 mm3 [95% CI, 73.4-140.3 mm3]), and right posterior thalamic radiation (intensive treatment, 49.5 mm3 [95% CI, 24.3-74.7 mm3]; standard treatment, 102.6 mm3 [95% CI, 71.0-134.2 mm3]).1

“Our study shows that specific areas have greater benefit, representing sensitive regions to track in future trials evaluating small-vessel disease,” said Tanweer Rashid, PhD, of the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases.2

References:

  1. Rashid T, Li K, Toledo JB, et al. Association of Intensive vs Standard Blood Pressure Control With Regional Changes in Cerebral Small Vessel Disease Biomarkers: Post Hoc Secondary Analysis of the SPRINT MIND Randomized Clinical Trial. JAMA Netw Open. 2023;6(3):e231055. Published March 1, 2023. Accessed April 25, 2023. doi:10.1001/jamanetworkopen.2023.1055
  2. Sansom W. Keeping a tighter rein on blood pressure in adults over 50 is desirable for Brain Health. UT Health San Antonio. https://news.uthscsa.edu/keeping-a-tighter-rein-on-blood-pressure-in-adults-over-50-is-desirable-for-brain-health/. Published April 21, 2023. Accessed April 25, 2023.
  3. Systolic blood pressure intervention trial. American College of Cardiology. https://www.acc.org/latest-in-cardiology/clinical-trials/2015/09/23/10/40/sprint. Published May 3, 2021. Accessed April 25, 2023.
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