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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.
See this image and copyright information in PMC

Comment in

References

    1. Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med [Internet]. 2014;275:214–228. Available from: http://doi.wiley.com/10.1111/joim.12190 - DOI - PMC - PubMed
    1. Mitchell AJ, Shiri-Feshki M. Rate of progression of mild cognitive impairment to dementia - meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand [Internet]. 2009;119:252–265. Available from: http://doi.wiley.com/10.1111/j.1600-0447.2008.01326.x - DOI - PubMed
    1. Aisen PS, Andrieu S, Sampaio C, Carrillo M, Khachaturian ZS, Dubois B, Feldman HH, Petersen RC, Siemers E, Doody RS, Hendrix SB, Grundman M, Schneider LS, Schindler RJ, Salmon E, Potter WZ, Thomas RG, Salmon D, Donohue M, Bednar MM, Touchon J, Vellas B. Report of the task force on designing clinical trials in early (predementia) AD. Neurology [Internet]. 2011;76:280–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21178097 - PMC - PubMed
    1. Smith EE, Cieslak A, Barber P, Chen J, Chen Y-W, Donnini I, Edwards JD, Frayne R, Field TS, Hegedus J, Hanganu V, Ismail Z, Kanji J, Nakajima M, Noor R, Peca S, Sahlas D, Sharma M, Sposato LA, Swartz RH, Zerna C, Black SE, Hachinski V. Therapeutic Strategies and Drug Development for Vascular Cognitive Impairment. J Am Heart Assoc [Internet]. 2017;6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28476873 - PMC - PubMed
    1. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med [Internet]. 2004;256:240–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15324367 - PubMed

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