Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Palta P, Albert MS, Gottesman RF. Heart health meets cognitive health: evidence on the role of blood pressure. Lancet Neurol. (2021) 20:854–67. 10.1016/S1474-4422(21)00248-9 - DOI - PMC - PubMed
    1. National Academies of Sciences E Medicine Health Medicine D Board Board on Health Sciences P Committee Committee on Preventing D . In: Downey A, Stroud C, Landis S, Leshner AI, editors. Preventing Cognitive Decline and Dementia: A Way Forward. Washington, DC: National Academies Press (US). (2017). - PubMed
    1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. (2005) 365:217–23. 10.1016/S0140-6736(05)17741-1 - DOI - PubMed
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. . Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. (2016) 134:441–50. 10.1161/CIRCULATIONAHA.115.018912 - DOI - PMC - PubMed
    1. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. . Dementia prevention, intervention, and care: 2020 report of the lancet commission. Lancet. (2020) 396:413–46. 10.1016/S0140-6736(20)30367-6 - DOI - PMC - PubMed

Associated data