Kidney Disease, Intensive Hypertension Treatment, and Risk for Dementia and Mild Cognitive Impairment: The Systolic Blood Pressure Intervention Trial
Year: 2020
Type: article
Abstract: Significance Statement Intensive treatment of hypertension is beneficial for cardiovascular disease and cognitive function, but at the short-term expense of reduced kidney function. In a randomized trial of intensive versus standard systolic BP lowering, the authors found an association between a large decline in eGFR and increased incidence of probable dementia and mild cognitive impairment, but no link between urinary albumin-to-creatinine ratio and occurrence of dementia or mild cognitive impairment. Decline in eGFR occurred more frequently in the intensive treatment group, but did not modify the beneficial effect of intensive treatment on cognitive function. Among hypertensive adults, declining eGFR may be a marker for those at higher risk for dementia or mild cognitive impairment, independent of the intensity of hypertension treatment. Background Intensively treating hypertension may benefit cardiovascular disease and cognitive function, but at the short-term expense of reduced kidney function. Methods We investigated markers of kidney function and the effect of intensive hypertension treatment on incidence of dementia and mild cognitive impairment (MCI) in 9361 participants in the randomized Systolic Blood Pressure Intervention Trial, which compared intensive versus standard systolic BP lowering (targeting <120 mm Hg versus <140 mm Hg, respectively). We categorized participants according to baseline and longitudinal changes in eGFR and urinary albumin-to-creatinine ratio. Primary outcomes were occurrence of adjudicated probable dementia and MCI. Results Among 8563 participants who completed at least one cognitive assessment during follow-up (median 5.1 years), probable dementia occurred in 325 (3.8%) and MCI in 640 (7.6%) participants. In multivariable adjusted analyses, there was no significant association between baseline eGFR <60 ml/min per 1.73 m 2 and risk for dementia or MCI. In time-varying analyses, eGFR decline ≥30% was associated with a higher risk for probable dementia. Incident eGFR <60 ml/min per 1.73 m 2 was associated with a higher risk for MCI and a composite of dementia or MCI. Although these kidney events occurred more frequently in the intensive treatment group, there was no evidence that they modified or attenuated the effect of intensive treatment on dementia and MCI incidence. Baseline and incident urinary ACR ≥30 mg/g were not associated with probable dementia or MCI, nor did the urinary ACR modify the effect of intensive treatment on cognitive outcomes. Conclusions Among hypertensive adults, declining kidney function measured by eGFR is associated with increased risk for probable dementia and MCI, independent of the intensity of hypertension treatment.
Institutions: VA Palo Alto Health Care System, Stanford Medicine, Stanford University, Wake Forest University Health Sciences, Wake Forest University, University of Utah, The Ohio State University, Mayo Clinic in Florida, University of Minnesota, University of Alabama at Birmingham, UAB Medicine, University of California San Diego, Tufts Medical Center
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Alzheimer's Association, National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G130883262, G1346455397, G1425514332, G1452718737, G1534123016, G1575401839, G1815451664, G219693323, G2244966566, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, G2866321202, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3042542605, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, G4018866504, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G467313275, SPRINT MIND 2020, G5068655555, G5185313375, G522538789, Institutional Clinical and Translational Science Award, MIND the Kidneys, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G709749280, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, G8624175963, G8723760441, Clinical and Translational Science Collaborative of Cleveland, G884570035, G94668252
OpenAlex ID: W3037568390