In Reply We very much appreciate the careful reading of our article by Zhang and colleagues. Their research, and the work of others, on the adverse impact of type 2 diabetes mellitus in autoregulation of various organ systems makes plausible their proposed explanation for the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) blood pressure trial findings. This is one of several mechanisms that have been postulated. Fortuitously, we will be able to test this particular proposed mechanism at the conclusion of the ongoing Systolic Pressure Intervention Trial (SPRINT) (clinicaltrials.gov identifier: NCT01206062). This important trial, sponsored by 4 Institutes within the National Institutes of Health, is testing the same blood pressure lowering protocol used in ACCORD but this time in persons without diagnosed type 2 diabetes. SPRINT will couple a somewhat more extensive cognitive assessment with brain magnetic resonance imaging, including assessments of blood flow and neural networks. The results are expected during early 2017.
Williamson JD, Launer LJ, Miller ME, For the ACCORD MIND Investigators. Faster Brain Shrinkage in the ACCORD MIND Study—Reply. JAMA Intern Med. 2015;175(1):144-145. doi:10.1001/jamainternmed.2014.6991