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. 2023 Feb 1:14:1042637.
doi: 10.3389/fneur.2023.1042637. eCollection 2023.

Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial

Jiali Fan  1 , Jingjing Bai  1 , Wei Liu  2 , Jun Cai  1
Affiliations

Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial

Jiali Fan et al. Front Neurol. .

Abstract

Background: The STEP (Strategy of Blood Pressure Intervention in the older Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control resulted in a lower incidence of cardiovascular events than standard treatment. This study analyzed the effects of intensive SBP lowering on cognitive function.

Methods: STEP was a multicenter, randomized controlled trial of hypertensive patients aged 60-80 years. Participants were randomly assigned (1:1) to SBP goals of 110-130 mmHg (intensive treatment) or 130-150 mmHg (standard treatment). Each individual was asked to complete a cognitive function test (Mini-Mental State Examination; MMSE) at baseline and during follow-up. The primary outcome for this study was the annual change in MMSE score. Subjects with a score less than education-specific cutoff point were categorized as cognitive decline.

Results: The analysis enrolled 6,501 participants (3,270 participants in the intensive-treatment and 3,231 participants in the standard-treatment groups). Median follow-up was 3.34 years. There was a minor change in MMSE score, with an annual change of -0.001 [95% confidence interval [CI] -0.020, 0.018] and 0.030 (95% CI 0.011, 0.049) in the intensive- and standard-treatment groups, respectively (p = 0.052). Cognitive decline occurred in 46/3,270 patients (1.4%) in the intensive-treatment group and 42/3,231 (1.3%) in the standard-treatment group (hazard ratio 0.005, 95% CI 0.654, 1.543, p = 0.983).

Conclusions: Compared with standard treatment, intensive SBP treatment did not result in a significant change in cognitive function test score. The impact of intensive blood pressure lowering was not evident using this global cognitive function test.

Trial registration: ClinicalTrials.gov. Unique identifier: NCT03015311.

Keywords: Mini-Mental State Examination; cardiovascular events; cognitive function; intensive BP treatment; standard BP treatment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Screening, randomization, and follow-up of participants in this cognitive function analysis.
Figure 2
Figure 2
Annual change in MMSE score during follow-up. Solid lines denote estimated mean MMSE for each treatment group based on a robust linear mixed model. Shaded regions indicate 95% confidence intervals. MMSE, Mini-Mental State Examination.
Figure 3
Figure 3
Potential cognitive impairment by treatment group. Hazard ratio 1.005; 95% CI, 0.654, 1.543, p = 0.983 for group comparison of incidence.
See this image and copyright information in PMC

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