Cerebral small vessel disease and effects of intensive versus standard blood pressure treatment on cardiovascular outcomes and adverse events
Year: 2025
Type: article
Abstract: OBJECTIVES: The safety of intensive blood pressure lowering in patients with preexisting cerebral small vessel disease (CSVD) remains unclear. METHODS: We used data from 759 participants in Systolic Blood Pressure Intervention Trial (SPRINT) who completed a baseline MRI, and categorized participants by the median abnormal white matter hyperintensity volume (WMHv, <3.2 cm 3 versus ≥3.2 cm 3 ). We estimated the association of the baseline WMHv with cardiovascular outcomes and adverse events using Cox proportional hazards models adjusted for treatment assignment, age, sex, MRI scanner, and intracranial volume. We used stratified analysis to determine the effect of intensive versus standard treatment by the baseline WMHv. RESULTS: The mean age of the participants was 68 ± 9 years and 39% were female. In adjusted models, adults with WMHv above the median had an increased risk of the primary cardiovascular composite outcome [hazard ratio (HR) 2.59, 95% confidence interval (CI) 1.39, 4.81], all-cause mortality (HR 2.06, 95% CI 0.97, 4.37), and mild cognitive impairment or probable dementia (HR 1.76, 95% CI 0.99, 3.13). While the effects of intensive versus standard blood pressure treatment were similar for most outcomes by WMHv, intensive treatment was associated with a higher risk for mild cognitive impairment or probable dementia among adults with a WMHv above the median (HR 2.36, 95% CI 1.20, 4.66), but not among adults with a WMHv below the median (p-value for interaction = 0.09). CONCLUSIONS: In this posthoc analysis of SPRINT, adults with a higher WMHv were at a higher risk for adverse cardiovascular and cognitive outcomes. Among these adults, intensive blood pressure treatment reduced cardiovascular events, while its effects on the risk of cognitive impairment or dementia in this subgroup merit further study.
Source: Journal of Hypertension
Language: English
Subfield: Neurology
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 Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1201304535, G1300843396, G130883262, G1346455397, G1452718737, G1534123016, G1575401839, G1815451664, The Ohio State University Center for Clinical and Translational Science (UL1), G3042542605, Translational Research in Hypertension and Renal Biology, G3759862710, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, SPRINT MIND 2020, G5068655555, G522538789, MIND the Kidneys, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, Biomedical Image Computing and Informatics Cluster, G6355517600, G742032275, The Stanford Pre-Renal Initiative: Undergraduate Training in Kidney Health, The Vanderbilt Institute for Clinical and Translational Research (VICTR), G8723760441, G884570035
OpenAlex ID: W4411823311