Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial

Area of Science:

• Neurology
• Cardiology
• Geriatrics

Background:

• No proven treatments currently exist to reduce the risk of mild cognitive impairment and dementia.
• Hypertension is a modifiable risk factor for cognitive decline.

Purpose of the Study:

• To evaluate the effect of intensive blood pressure control on the risk of dementia.

Main Methods:

• A randomized clinical trial involving 9361 adults aged 50+ with hypertension.
• Participants were randomized to a systolic blood pressure goal of <120 mm Hg (intensive) or <140 mm Hg (standard).
• Cognitive outcomes included probable dementia and mild cognitive impairment.

Main Results:

• Intensive blood pressure control did not significantly reduce the risk of probable dementia (HR, 0.83; 95% CI, 0.67-1.04).
• Intensive control significantly reduced the risk of mild cognitive impairment (HR, 0.81; 95% CI, 0.69-0.95).
• A combined outcome of mild cognitive impairment or probable dementia was also reduced (HR, 0.85; 95% CI, 0.74-0.97).

Conclusions:

• Treating to a systolic blood pressure goal of <120 mm Hg did not significantly reduce the risk of probable dementia compared to <140 mm Hg.
• The study may have been underpowered to detect a significant difference in dementia risk due to early termination and fewer cases than expected.