There appear to be no detrimental effects on cognitive function and cerebral perfusion in patients with lower baseline diastolic blood pressure (DBP) receiving intensive systolic BP (SBP) control, according to a study published in Hypertension.
Investigators sought to assess the effect of intensive SBP control on cognitive outcomes and cerebral blood flow across various baseline levels of DBP.
They initiated a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension; ClinicalTrials.gov Identifier: NCT01206062) study that randomly assigned participants to BP targets of either intensive (<120 mm Hg [n=4278]) or standard (<140 mm Hg [n=4385]). Participants were aged at least 50 years and those with history of dementia, heart failure, diabetes, or stroke were excluded. The analysis assessed BP intervention effects on cognitive outcomes and cerebral blood flow across various baseline DBP quartiles.
Regardless of DBP quartiles, participants in the intensive group had a lower incidence rate of mild cognitive impairment or probable dementia than participants in the standard group. There were similar results for mild cognitive impairment (P interaction=.80) and for probable dementia (P interaction=.06). Hazard ratios relating BP control with the risk for mild cognitive impairment in the lowest DBP quartile was 0.78 (95% CI, 0.61-1.00), and in the highest DBP quartile it was 0.70 (95% CI, 0.46-1.07). Hazard ratios relating BP control with the risk for probable dementia in the lowest DBP quartile was 1.05 (95% CI, 0.76-1.47), and in the highest DBP quartile it was 0.56 (95% CI, 0.29-1.07).
The intensive treatment effect on cerebral blood flow was not modified by baseline DBP (P interaction=.25). There was an increasing trend of annualized change in cerebral blood flow (+0.26 mL/100g/min; 95% CI, -0.72 to 1.24) with participants in the lowest DBP quartile, intensive vs standard BP treatment.
Participants with the lowest baseline DBP had the highest incidence rates of serious adverse events. No significant interactions were noted between intensive SBP reduction and baseline DBP quartile for any serious adverse event (all P interaction >.05).
Limitations of the study include the post hoc study design and it possibly being underpowered to detect the effect of BP intervention on cognitive outcomes. There was also significant loss to follow-up and the exclusion of patients with prior heart failure, diabetes, dementia, or stroke could lead to lack of generalizability.
“…patients with lower DBP had a higher incidence of dementia or MCI (mild cognitive impairment),” the study authors wrote. “…intensive BP control did not appear to have a detrimental effect on cognitive function and cerebral perfusion.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Jiang C, Li S, Wang Y, et al. Diastolic blood pressure and intensive blood pressure control on cognitive outcomes: insights from the SPRINT MIND trial. Hypertension. Published online January 23, 2023. doi:10.1161/HYPERTENSIONAHA.122.20112