AAIC 2018: Could intensive blood pressure control reduce the risk of MCI and dementia?

Written by Sharon Salt, Editor

At the Alzheimer’s Association International Conference (AAIC; 22–26 July, IL, USA), Jeff Williamson (Wake Forest School of Medicine, NC, USA) announced results from the SPRINT MIND study. For the first time, the trial demonstrated significant reductions in the risk of mild cognitive impairment (MCI) and the combination of MCI and dementia through aggressive lowering of systolic blood pressure.
The results of this large-scale, long-term clinical trial provide the strongest evidence to date about reducing risk of MCI and dementia through the treatment of high blood pressure.

“This study shows more conclusively than ever before that there are things you can do — especially regarding cardiovascular disease risk factors — to reduce your risk of MCI and dementia,” said Maria Carrillo, Chief Science Officer at the Alzheimer’s Association (IL, USA). “To reduce new cases of MCI and dementia globally we must do everything we can — as professionals and individuals — to reduce blood pressure to the levels indicated in this study, which we know is beneficial to cardiovascular risk.”

According to Carrillo, these results fit well with recent population data demonstrating reductions in new cases of dementia in developed Western cultures. It is believed that these lower rates of dementia may be occurring as these societies have begun to improve control of cardiovascular risk factors through medication management, reducing smoking and greater awareness of healthy lifestyle.

“The future of reducing MCI and dementia could be in treating the whole person with a combination of drugs and modifiable risk factor interventions — as we do now in heart disease,” Carrillo suggested. “These new blood pressure findings raise our level of anticipation for the US POINTER study, which includes managing cardiovascular disease risk factors as part of the multi-component lifestyle intervention.”

The US POINTER study is a 2-year clinical trial funded by the Alzheimer’s Association to evaluate whether lifestyle interventions can protect cognitive function in older adults at increased risk for cognitive decline.

The SPRINT trials

At AAIC 2018, preliminary results related to risk of dementia and cognitive decline from the SPRINT trial were reported. SPRINT is a randomized clinical trial that compared two strategies for managing hypertension in older adults (an intensive strategy with a systolic blood pressure goal of less than 140 mmHg). Previously, SPRINT demonstrated that more intensive blood pressure control reduced the risk for cardiovascular morbidity and mortality.

In addition to this, the SPRINT MIND study examined whether treating to the lower blood pressure target reduces the risk of developing dementia and/or MCI, and reduces the total volume of white matter lesions in the brain as shown by MRI.

The study participants included 9361 hypertensive older adults with increased cardiovascular risk but without diagnosed diabetes, dementia or prior stroke. At least 8626 (92.1%) completed at least on follow-up cognitive assessment.

In SPRINT MIND, the researchers found a statistically significant 19% lower rate of new cases of MCI (p = 0.01) in the intensive blood pressure treatment group. The combined outcome of MCI plus probable all-cause dementia was 15% lower (p = 0.02) in the intensive versus standard treatment group. There was a non-significant reduction in probable dementia alone (p = 0.10).

“These results support the need to maintain well-controlled blood pressure, especially for persons over the age of 50,” stated Williamson. “A particular strength of SPRINT-MIND is that 30% of the participants were African–American and 10% were Hispanic.”

“This is something doctors and the majority of their community dwelling patients with elevated blood pressure should be doing now to keep their hearts — and brains — healthier. These new results for maintaining cognitive health provide another strong rationale for starting and maintaining healthy lifestyle changes in mid-life,” Williamson concluded.

Sources: Williamson J et al. A randomized trial of intensive versus standard systolic blood pressure control and the risk of mild cognitive impairment and dementia: results from SPRINT MIND. Presented at: Alzheimer’s Association International Conference, Chicago, IL, USA, 22–26 July 2018; www.alz.org/aaic/2018_news_releases.asp

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