Blood Pressure Variability and Cognitive Decline: A Post Hoc Analysis of the SPRINT MIND Trial.

Pubmed ID: 36448621

Pubmed Central ID: PMC10208742

Journal: American journal of hypertension

Publication Date: Feb. 24, 2023

MeSH Terms: Humans, Hypertension, Blood Pressure, Antihypertensive Agents, Dementia, Cognitive Dysfunction

Grants: P30 AG066519, R01 AG060049, R01 AG064228

Authors: Sible IJ, Nation DA

Cite As: Sible IJ, Nation DA. Blood Pressure Variability and Cognitive Decline: A Post Hoc Analysis of the SPRINT MIND Trial. Am J Hypertens 2023 Feb 24;36(3):168-175.

Studies:

Abstract

BACKGROUND: Blood pressure (BP) variability (BPV) is an emerging risk factor for cognitive impairment and dementia, but relationships with cognition in the context of antihypertensive strategies remain unclear. We examined whether visit-to-visit BPV relates to cognitive change based on antihypertensive treatment type. METHODS: In this post hoc analysis of the SPRINT MIND trial, 2,348 participants underwent 4 BP measurements over a 9-month period after treatment randomization (standard vs. intensive BP lowering) and ≥ 1 neuropsychological evaluation thereafter. BPV was calculated as tertiles of BP SD. Participants underwent cognitive testing at baseline and every 2 years during the planned 4-year follow-up. Cognitive composite scores were calculated for global cognition, memory, language, executive function, and processing speed. Linear mixed models investigated relationships between BPV, antihypertensive treatment group, and time on cognitive composite scores. RESULTS: Elevated BPV was associated with the fastest decline in processing speed (ß = -.07 [95% CI -.12, -.01]; P = 0.02) and executive function (ß = -.08 [95% CI -.16, -.006]; P = 0.03) in the standard treatment group only. BPV was not related to cognitive change in the intensive treatment group. Mean/minimum/maximum BP was not associated with cognitive composite scores over time in either antihypertensive treatment group. CONCLUSIONS: Elevated BPV remains a risk for cognitive decline despite strictly controlled BP levels, in the standard treatment group. Specific declines were observed in processing speed and executive function, domains often impacted by cerebrovascular disease and may underpin risk for dementia and cerebrovascular disease associated with BPV. Clinical trial information: ClinicalTrials.gov; NCT01206062.