In adults with increased risk for cardiovascular disease but without diabetes, treating to a systolic blood pressure (BP) target less than 120 mmHg, as compared to a target of less than 140 mmHg, may reduce the risk of mild cognitive impairment (MCI) and the combined risk of MCI and dementia, according to preliminary results from the SPRINT MIND trial presented June 25 at the Alzheimer's Association International Conference in Chicago.

A substudy of the SPRINT trial – which randomized patients to either a standard group, with a target of less than 140 mm Hg, or an intensive-treatment group, with a target of less than 120 mm Hg – SPRINT MIND looked at 9,361 hypertensive older adults with increased cardiovascular risk but without diagnosed diabetes, dementia or stroke.

Results showed that at one year, mean systolic BP was 121.4 mmHg in the intensive-treatment group and 136.2 mmHg in the standard group. There was a "significantly lower rate" of adjudicated incident MCI and a "non-significant reduction" in the primary outcome of probable dementia. Secondary outcomes of a combined outcome of MCI plus probable dementia was significantly lower in the intensive vs. standard treatment group.

In related research also presented June 25 at the Alzheimer's Association International Conference, the SPRINT MIND MRI trial found that treating to a systolic BP target less than 120 mmHg also reduced the increases in cerebral white matter lesion (WML) on MRI scans, but found no significant change in total brain volume.

The study looked at 454 participants in the SPRINT trial who received follow-up MRIs at a median of 3.98 years post-randomization. Results showed that in the intensive-treatment group, WML volume increased by 0.28 cm3 vs. 0.92 cm3 in the standard treatment group. Total brain volume decreased by 27.3 cm3 in the intensive treatment group vs. 24.8 cm3 in the standard treatment group.

Update: Findings from the SPRINT MIND trial were published Jan. 28, 2019 in the Journal of the American Medical Association, and the authors found that among ambulatory adults with hypertension, treating to an systolic BP goal of less than 120 mm Hg vs. a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. They add that because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this endpoint.

Keywords: Blood Pressure, Random Allocation, Risk Factors, Hypertension, Systole, Stroke, Diabetes Mellitus, Dementia, Magnetic Resonance Imaging, National Institutes of Health (U.S.)

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