New research from the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrates that aggressively managing blood pressure can provide lasting cognitive benefits, reducing the risk of mild cognitive impairment and dementia in hypertensive adults. The study, published in Neurology, followed participants for up to seven years, revealing that the benefits of intensive blood pressure control persist even after treatment is stopped.
The SPRINT trial, conducted by researchers at Wake Forest University and other institutions across the US and Puerto Rico, involved 9,361 participants aged 50 and older with hypertension and high cardiovascular risk. Participants were randomized to either an intensive treatment group, targeting a systolic blood pressure of less than 120 mmHg, or a standard treatment group, targeting a systolic blood pressure of less than 140 mmHg. The initial intervention period lasted for an average of 3.3 years.
Sustained Cognitive Benefits
Cognitive assessments were conducted both in-person and via telephone to classify participants as having no cognitive impairment, mild cognitive impairment (MCI), or probable dementia. The follow-up study, which re-contacted over 7,000 participants from the initial trial, found that those in the intensive treatment group had a sustained lower incidence of developing cognitive impairment compared to the standard treatment group.
Specifically, individuals who underwent intensive blood pressure treatment were 13% less likely to develop mild cognitive impairment and 11% less likely to develop either mild cognitive impairment or dementia, compared to those in the standard treatment group. These findings underscore the long-term protective effects of intensive blood pressure management on cognitive function.
Expert Commentary
"Our study shows that intensive blood pressure control is an important strategy in the prevention of cognitive impairment, a major cause of loss of independence in older adults," said Dr. Jeff Williamson, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine, and one of the study's authors. He added, "Lowering your blood pressure to more aggressive targets can improve the quality of life and extend active life for individuals with hypertension."
Dr. David M. Reboussin, a professor of biostatistics and data science at Wake Forest University's School of Medicine, and corresponding author, noted, "We found that the intensive treatment group had a sustained lower incidence of developing cognitive impairment compared to those in the standard treatment group."
Implications for Hypertension Management
These findings have significant implications for the management of hypertension, particularly in older adults at high cardiovascular risk. The results suggest that targeting lower blood pressure levels can not only reduce the risk of heart disease and death, as previously demonstrated by the SPRINT trial, but also provide lasting protection against cognitive decline.
While current blood pressure guidelines recommend a target of 120/80 mmHg or less, this study provides further evidence supporting more intensive blood pressure control in appropriate patients. Healthcare professionals may consider these findings when developing individualized treatment plans for patients with hypertension, especially those at risk of cognitive impairment.
Study Limitations
The researchers noted that the intensive treatment of hypertension was generally not maintained after the initial 3.3-year intervention period. Despite this, the cognitive benefits persisted, suggesting that even a few years of intensive treatment can have a lasting impact. Further research is needed to determine the optimal duration and intensity of blood pressure control for maximizing cognitive benefits.
