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Randomized Controlled Trial
. 2022 May;70(5):1384-1393.
doi: 10.1111/jgs.17583. Epub 2021 Nov 26.

Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study

Sarah A Gaussoin  1 , Nicholas M Pajewski  1 , Gordon Chelune  2 , Maryjo L Cleveland  3 , Michael G Crowe  4 , Lenore J Launer  5 , Alan J Lerner  6 , Jennifer Martindale-Adams  7 , Linda O Nichols  8 , Paula K Ogrocki  6 , Bonnie C Sachs  9 , Kaycee M Sink  10 , Mark A Supiano  11   12 , Virginia G Wadley  13 , Valerie M Wilson  3 , Clinton B Wright  14 , Jeff D Williamson  3 , David M Reboussin  1 , Stephen R Rapp  15
Affiliations
Randomized Controlled Trial

Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study

Sarah A Gaussoin et al. J Am Geriatr Soc. 2022 May.

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.

Keywords: MCI (mild cognitive impairment); blood pressure control; clinical trials.

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Figures

FIGURE 1.
FIGURE 1.
Five-state model for cognitive status
FIGURE 2.
FIGURE 2.
Occurrence of Mild Cognitive Impairment by Treatment group Shaded regions indicate 95% confidence intervals.
FIGURE 3.
FIGURE 3.
Occurrence of Subtypes of mild cognitive impairment by treatment group Shaded regions indicate 95% confidence intervals.
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