Control of Blood Pressure Reduces Risk of Cognitive Impairment

Raised blood pressure is one of the more important routes by which the low-level biochemical damage of aging results in structural and functional damage to delicate tissues - an outcome that is ultimately fatal in one way or another, as weakened blood vessels fail. Cross-links, cellular senescence, and other forms of biochemical change cause blood vessels to stiffen, which raises blood pressure. Increased blood pressure is influential enough in the course of aging that various pharmaceutical approaches to forcing lower blood pressure, interventions that work by overriding cellular reactions to rising levels of damage, can produce benefits despite failing to address the underlying damage. The data noted here is one example of many studies that show lower blood pressure to be a desirable goal in later life. Consider what might be achieved through actually targeting causes rather than just one of the many downstream consequences that lead to harm.

Significant reductions in the risk of mild cognitive impairment (MCI), and the combination of MCI and dementia, have been shown for the first time through aggressive lowering of systolic blood pressure. Researchers reported preliminary results related to risk of dementia and cognitive decline from the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT is a randomized clinical trial that compared two strategies for managing high blood pressure (hypertension) in older adults: an intensive strategy with a systolic blood pressure goal of less than 120 mm Hg versus a standard care strategy targeting a systolic blood pressure goal of less than 140 mm Hg. Previously, SPRINT demonstrated that more intensive blood pressure control reduced the risk for cardiovascular morbidity and mortality.

white matter lesions in the brain as shown by magnetic resonance imaging (MRI). Study participants were 9,361 hypertensive older adults with increased cardiovascular risk (based on the Framingham risk score) but without diagnosed diabetes, dementia, or prior stroke. Participant mean age was 67.9 years (35.6% women) and 8,626 (92.1%) completed at least one follow-up cognitive assessment.

Recruitment for SPRINT began in October 2010. At one year, mean systolic blood pressure was 121.4 mmHg in the intensive-treatment group and 136.2 mmHg in the standard treatment group. Treatment was stopped in August 2015 due to cardiovascular disease (CVD) benefit after a median follow up of 3.26 years, but cognitive assessment continued until June 2018. In SPRINT MIND, the researchers found a statistically significant 19 percent lower rate of new cases of MCI in the intensive blood pressure treatment group. The combined outcome of MCI plus probable all-cause dementia was 15 percent lower in the intensive versus standard treatment group.

Link: https://www.eurekalert.org/pub_releases/2018-07/aa-sib072218.php

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