Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial

Author:

Li Sitong1ORCID,Jiang Chao1ORCID,Wang Yufeng1,Lai Yiwei1,Zhao Manlin1,Li Qifan1,Bai Yu2ORCID,Dai Wenli1,Guo Qi1,He Liu1,Guo Xueyuan1,Wang Wei1,Li Songnan1,Liu Nian1,Jiang Chenxi1,Tang Ribo1,Sang Caihua1,Long Deyong1,Du Xin13ORCID,Dong Jianzeng14,Anderson Craig S.356ORCID,Ma Changsheng1ORCID

Affiliation:

1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).

2. School of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (Y.B.).

3. Heart Health Research Center, Beijing, China (X.D., C.S.A.).

4. Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.).

5. Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Australia (C.S.A.).

6. Faculty of Medicine, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.).

Abstract

BACKGROUND: The prognostic value of systolic blood pressure (SBP) time in target range (TTR) on cognitive outcomes among adults with hypertension remains unclear. METHODS: We performed secondary analysis of SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension), which compared intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP intervention in hypertensive individuals. TTR was calculated from baseline to month 3 using 110 to 130 mm Hg and 120 to 140 mm Hg as target range for the intensive and standard groups, respectively. Cognitive outcomes included probable dementia, mild cognitive impairment, and the composite of probable dementia or mild cognitive impairment. Cox regression models were used to evaluate the relationship between SBP-TTR and cognitive outcomes. RESULTS: A total of 8298 patients were included. Participants with higher TTR were younger and less likely to be women or to have a history of cardiovascular disease. After adjustment of baseline demographics, medical history, and mean SBP, a 1-SD (31.5%) increase in TTR was independently associated with a 14% lower risk of probable dementia (hazard ratio, 0.86 [95% CI, 0.76–0.98]; P =0.023). Sensitivity analysis showed consistent results when combining target range as 110 to 140 mm Hg. However, there was no significant association between SBP-TTR and mild cognitive impairment. CONCLUSIONS: In this post hoc analysis of SPRINT MIND, SBP-TTR was an independent predictor of probable dementia beyond mean SBP. Maintaining SBP within 110 to 140 mm Hg over time may be beneficial for dementia prevention. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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