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Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP

Jiali Fan1, Jingjing Bai1, Wei Liu2

  • 1Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Frontiers in Neurology
|February 23, 2023
PubMed

Insights

Intensive blood pressure control in older adults did not significantly alter cognitive function, as measured by the Mini-Mental State Examination. This finding suggests intensive systolic blood pressure lowering may not impact global cognition in this population.

Area of Science:

  • Gerontology
  • Cardiology
  • Neurology

Background:

  • The Strategy of Blood Pressure Intervention in older Hypertensive Patients (STEP) trial demonstrated cardiovascular benefits of intensive systolic blood pressure (SBP) control.
  • This secondary analysis investigates the impact of intensive SBP lowering on cognitive function in older hypertensive patients.

Purpose of the Study:

  • To evaluate the effect of intensive versus standard SBP control on cognitive function in hypertensive individuals aged 60-80 years.
  • To determine if intensive SBP lowering influences the rate of cognitive decline as assessed by the Mini-Mental State Examination (MMSE).

Main Methods:

  • A multicenter, randomized controlled trial involving 6,501 hypertensive patients aged 60-80 years.
  • Participants were assigned to intensive (SBP 110-130 mmHg) or standard (SBP 130-150 mmHg) treatment groups.
  • Cognitive function was assessed annually using the MMSE; cognitive decline was defined by a score below education-specific cutoffs.

Main Results:

  • No significant difference in the annual change of MMSE scores between the intensive (-0.001) and standard (0.030) treatment groups (p=0.052).
  • The incidence of cognitive decline was similar in both groups: 1.4% in the intensive group and 1.3% in the standard group (HR 0.005, p=0.983).
  • Median follow-up was 3.34 years.

Conclusions:

  • Intensive SBP control, compared to standard treatment, did not lead to a significant change in global cognitive function among older hypertensive patients.
  • The study suggests that intensive blood pressure lowering, within the tested range, may not have a discernible impact on cognitive function using the MMSE.
Abstract

Keywords:
Mini-Mental State Examinationcardiovascular eventscognitive functionintensive BP treatmentstandard BP treatment

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