Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study
Year: 2021
Type: article
Abstract: BACKGROUND: To examine the effect of intensive blood pressure control on the occurrence of subtypes of mild cognitive impairment (MCI) and determine the risk of progression to dementia or death. METHODS: Secondary analysis of a randomized trial of community-dwelling adults (≥50 years) with hypertension. Participants were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment; n = 4678) or <140 mm Hg (Standard treatment; n = 4683). Outcomes included adjudicated MCI, MCI subtype (amnestic, non-amnestic, multi-domain, single domain), and probable dementia. Multistate survival models were used to examine transitions in cognitive status accounting for the competing risk of death. RESULTS: Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 640 participants met the protocol definition for MCI, with intensive treatment reducing the risk of MCI overall (hazard ratio [HR], 0.81 [95% confidence interval {CI}, 0.69-0.94]), as previously reported. This effect was largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66-0.92]) and multi-domain subtypes (HR, 0.78 [95% CI, 0.65-0.93]). An adjudication of MCI, as compared with normal cognitive function, substantially increased the probability of progressing to probable dementia (5.9% [95% CI: 4.5%-7.7%] vs. 0.6% [95% CI: 0.3%-0.9%]) and to death (10.0% [95% CI: 8.3%-11.9%] vs. 2.3% [95% CI: 2.0%-2.7%]) within 2 years. CONCLUSIONS: Intensive treatment reduced the risk for amnestic and multi-domain subtypes of MCI. An adjudication of MCI was associated with increased risk of progression to dementia and death, highlighting the relevance of MCI as a primary outcome in clinical and research settings.
DOI: 10.1111/jgs.17583
Authors: Sarah A. Gaussoin, Nicholas M. Pajewski, Gordon Chelune, Maryjo L. Cleveland, Michael G. Crowe, Lenore J. Launer, Alan J. Lerner, Jennifer Martindale‐Adams, Linda O. Nichols, Paula K. Ogrocki, Bonnie C. Sachs, Kaycee M. Sink, Mark A. Supiano, Virginia G. Wadley, Valerie M. Wilson, Clinton B. Wright, Jeff D. Williamson, David M. Reboussin, Stephen R. Rapp
Institutions: Wake Forest University Health Sciences, Wake Forest University, University of Utah, University of Alabama at Birmingham, National Institutes of Health, National Institute on Aging, Case Western Reserve University, University of Tennessee Health Science Center, Memphis VA Medical Center, Genentech, VA Salt Lake City Healthcare System, UAB Medicine, National Institute of Neurological Disorders and Stroke
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: 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, G1153142239, G1201304535, G130883262, G1346455397, G1413684730, G1452718737, G1534123016, G1575401839, G1815451664, G219693323, G2244966566, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3042542605, G352185580, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, G4061291167, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G4186766937, SPRINT MIND 2020, G5068655555, G522538789, Institutional Clinical and Translational Science Award, G5497268829, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, G8723760441, Clinical and Translational Science Collaborative of Cleveland, G884570035
OpenAlex ID: W3215836782