Related Experiment Video
Updated: Jun 3, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cardiac Biomarkers, Subclinical Brain Vascular Changes, and Cognitive Decline: Post Hoc Analysis of the SPRINT Trial
Wenxin Zhang1, Simon B Ascher2,3, Sudipto Dolui4
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Insights
Subclinical cardiovascular disease in hypertensive adults is linked to faster cognitive decline and white matter lesions. Intensive blood pressure treatment did not alter this association, suggesting CVD impacts brain health independently.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Subclinical cardiovascular disease (CVD) and its impact on cognitive decline in hypertensive individuals are not fully understood.
- The role of underlying brain pathologies and the effect of intensified blood pressure (BP) treatment on cognitive decline in this population remain unclear.
Purpose of the Study:
- To investigate the association between subclinical CVD markers and cognitive decline in hypertensive adults.
- To determine if intensive BP treatment influences cognitive decline in the presence of subclinical CVD.
Main Methods:
- Post hoc analysis of the Systolic Blood Pressure Intervention Trial involving 2,733 participants.
- Subclinical CVD identified by elevated high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
- Cognitive function assessed at baseline and follow-up; brain imaging (MRI) performed on a subset.
Main Results:
- Elevated hs-cTnT and NT-proBNP were associated with accelerated cognitive decline across all domains.
- Individuals with both elevated biomarkers exhibited the most rapid decline in global cognitive function.
- Elevated biomarkers correlated with increased white matter lesions but not with changes in brain volume or blood flow.
Conclusions:
- Subclinical CVD may accelerate cognitive decline and white matter lesion progression in hypertensive patients.
- Intensive BP treatment did not mitigate the negative effects of subclinical CVD on cognitive function.
Background:
The association between subclinical cardiovascular disease (CVD) and cognitive decline in hypertensive adults and the underlying brain pathologies remain unclear. It is also undetermined whether intensifying blood pressure (BP) treatment slows down cognitive decline associated with subclinical CVD.
Methods:
We conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial. Subclinical CVD at baseline was identified by elevated levels of high-sensitivity cardiac troponin T (hs-cTnT ≥ 14 ng/L) and N-terminal pro-B-type natriuretic peptide (NT-proBNP ≥ 125 pg/mL). Global cognitive function and domain-specific measures (memory, processing speed, language, and executive function) were assessed at baseline and follow-up (years 2, 4, and 6) in 2 733 participants. White matter lesions, cerebral blood flow, and brain tissue volume were assessed by MRI at baseline and year 4 in a subset of 639 participants.
Results:
Both elevated hs-cTnT and NT-proBNP levels at baseline were associated with accelerated cognitive decline across all domains after adjusting for potential confounding factors. The group with elevated levels of both cardiac biomarkers showed the fastest decline, with a larger annual decline rate of 0.033 (95% CI: 0.024-0.041) in the z-score of global cognitive function compared with the group with normal levels. Elevated levels of both biomarkers were also associated with a faster progression in white matter lesions, but not with changes in total brain tissue volume or cerebral blood flow. Intensive BP treatment did not attenuate these associations compared with standard treatment.
Conclusions:
Subclinical CVD may contribute to faster white matter lesion progression and accelerated cognitive decline in patients with hypertension, regardless of intensive BP treatment.
