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Original Investigation
January 28, 2019

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

The SPRINT MIND Investigators for the SPRINT Research Group
JAMA. 2019;321(6):553-561. doi:10.1001/jama.2018.21442
Key Points

Question  Does intensive blood pressure control reduce the occurrence of dementia?

Findings  In this randomized clinical trial that included 9361 adults with hypertension, randomization to a systolic blood pressure target of less than 120 mm Hg compared with less than 140 mm Hg resulted in a rate of probable dementia of 7.2 vs 8.6 cases per 1000 person-years, a difference that was not statistically significant.

Meaning  Among adults with hypertension, intensive blood pressure control did not significantly reduce the risk of probable dementia.

Abstract

Importance  There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia.

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

Design, Setting, and Participants  Randomized clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. The final date for follow-up of cognitive outcomes was July 22, 2018.

Interventions  Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683).

Main Outcomes and Measures  The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia.

Results  Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67-1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97).

Conclusions and Relevance  Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point.

Trial Registration  ClinicalTrials.gov Identifier: NCT01206062

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