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Comment & Response
January 2015

Faster Brain Shrinkage in the ACCORD MIND Study: An Unexpected Result?

Author Affiliations
  • 1Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
JAMA Intern Med. 2015;175(1):144. doi:10.1001/jamainternmed.2014.6971

To the Editor In the context of the current controversy regarding the optimal goal for blood pressure (BP) control triggered by the publication of “JNC 8” (Eighth Joint National Committee),1 one more dismaying finding from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial published in JAMA Internal Medicine has cast additional doubts on the potential benefits of intensive BP lowering in older adults. The ACCORD Memory in Diabetes (MIND) study, a substudy of the main ACCORD trial, reported that intensive lowering of systolic BP to a target of lower than 120 mm Hg caused more declines in total brain volume (TBV) measured with magnetic resonance imaging, a surrogate of neurodegeneration, in older adults with established type 2 diabetes mellitus (T2DM) compared with those who received a standard therapy of lowering systolic BP below 140 mm Hg.2 No differences in cognitive function were observed between the intensive and standard BP interventions. These observations are “unexpected” in that the study authors hypothesized that intensive BP lowering would result in less, rather than more, declines in TBV and thus better brain health.

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