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Clinical Trial
. 2023 Feb 24;36(3):168-175.
doi: 10.1093/ajh/hpac128.

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

Isabel J Sible  1 , Daniel A Nation  2   3
Affiliations
Clinical Trial

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

Isabel J Sible et al. Am J Hypertens. .

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.

Keywords: antihypertensives; blood pressure variability; cognition; executive functioning; processing speed.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
| Elevated BPV is associated with processing speed and executive function decline in standard treatment group only. Conditional effects of BPV by time by antihypertensive treatment group on (A) standardized processing speed composite score and (B) standardized executive function composite score. Lines represent rate of change for each tertile of BPV (blue = 1st tertile of BPV; orange = 2nd tertile of BPV; green = 3rd tertile of BPV). Models adjusted for age, sex, race/ethnicity, education, adjudicated clinical diagnosis, history of cardiovascular disease, and mean BP. BPV, blood pressure variability.
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