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

被引：786

作者：

Williamson, Jeff D. ^{[1
]}

Pajewski, Nicholas M. ^{[2
]}

Auchus, Alexander P. ^{[3
]}

Bryan, R. Nick ^{[4
]}

Chelune, Gordon ^{[5
]}

Cheung, Alfred K. ^{[6
]}

Cleveland, Maryjo L. ^{[1
]}

Coker, Laura H. ^{[7
]}

Crowe, Michael G. ^{[8
]}

Cushman, William C. ^{[9
]}

Cutler, Jeffrey A. ^{[10
]}

Davatzikos, Christos ^{[4
]}

Desiderio, Lisa ^{[4
]}

Erus, Guray ^{[4
]}

Fine, Larry J. ^{[11
]}

Gaussoin, Sarah A. ^{[2
]}

Harris, Darrin ^{[2
]}

Hsieh, Meng-Kang ^{[4
]}

Johnson, Karen C. ^{[12
]}

Kimmel, Paul L. ^{[13
]}

Tamura, Manjula Kurella ^{[14
]}

Launer, Lenore J. ^{[15
]}

Lerner, Alan J. ^{[16
]}

Lewis, Cora E. ^{[17
]}

Martindale-Adams, Jennifer ^{[12
]}

Moy, Claudia S. ^{[18
]}

Nasrallah, Ilya M. ^{[4
]}

Nichols, Linda O. ^{[9
]}

Oparil, Suzanne ^{[19
]}

Ogrocki, Paula K. ^{[16
]}

Rahman, Mahboob ^{[20
]}

Rapp, Stephen R. ^{[21
]}

Reboussin, David M. ^{[2
]}

Rocco, Michael V. ^{[22
]}

Sachs, Bonnie C. ^{[23
]}

Sink, Kaycee M. ^{[1
]}

Still, Carolyn H. ^{[24
]}

Supiano, Mark A. ^{[25
]}

Snyder, Joni K. ^{[10
]}

Wadley, Virginia G. ^{[19
]}

Walker, Jennifer ^{[1
]}

Weiner, Daniel E. ^{[26
]}

Whelton, Paul K. ^{[27
]}

Wilson, Valerie M. ^{[1
]}

Woolard, Nancy ^{[1
]}

Wright, Jackson T., Jr. ^{[28
]}

Wright, Clinton B. ^{[18
]}

机构：

[1] Wake Forest Sch Med, Dept Internal Med, Sect Gerontol & Geriatr Med, Winston Salem, NC USA

[2] Wake Forest Sch Med, Dept Biostat & Data Sci, Winston Salem, NC USA

[3] Univ Mississippi, Med Ctr, Dept Neurol, Jackson, MS 39216 USA

[4] Univ Penn, Dept Radiol, Philadelphia, PA 19104 USA

[5] Univ Utah, Sch Med, Dept Neurol, Salt Lake City, UT USA

[6] Univ Utah, Sch Med, Div Nephrol & Hypertens, Salt Lake City, UT USA

[7] Wake Forest Sch Med, Dept Social Sci & Hlth Policy, Winston Salem, NC USA

[8] Univ Alabama Birmingham, Dept Psychol, Birmingham, AL 35294 USA

[9] Vet Affairs Med Ctr, Prevent Med Sect, Memphis, TN USA

[10] NHLBI, Div Cardiovasc Sci, Bldg 10, Bethesda, MD 20892 USA

[11] NHLBI, Clin Applicat & Prevent Branch, Bldg 10, Bethesda, MD 20892 USA

[12] Univ Tennessee, Ctr Hlth Sci, Dept Prevent Med, Memphis, TN 38163 USA

[13] Natl Inst Diabet & Digest & Kidney Disorders, Div Kidney Urol & Hematol Dis, Bethesda, MD USA

[14] Stanford Univ, Sch Med, Div Nephrol, Palo Alto, CA 94304 USA

[15] NIA, Neuroepidemiol Sect, Intramural Res Program, Bethesda, MD 20892 USA

[16] Case Western Reserve Univ, Sch Med, Dept Neurol, Cleveland, OH 44106 USA

[17] Univ Alabama Birmingham, Dept Epidemiol, Birmingham, AL USA

[18] Natl Inst Neurol Disorders & Stroke, Bethesda, MD USA

[19] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA

[20] Case Western Reserve Univ, Dept Med, Louis Stokes Cleveland Vet Affairs Med Ctr, Cleveland, OH 44106 USA

[21] Wake Forest Sch Med, Dept Psychiat & Behav Med, Winston Salem, NC USA

[22] Wake Forest Sch Med, Dept Internal Med, Nephrol Sect, Winston Salem, NC USA

[23] Wake Forest Sch Med, Dept Neurol, Winston Salem, NC USA

[24] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44106 USA

[25] Univ Utah, Sch Med, Div Geriatr, Salt Lake City, UT USA

[26] Tufts Med Ctr, Div Nephrol, Boston, MA USA

[27] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA USA

[28] Case Western Reserve Univ, Dept Med, Div Nephrol & Hypertens, Cleveland, OH 44106 USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2019年 / 321卷 / 06期

关键词：

MILD COGNITIVE IMPAIRMENT; ALZHEIMERS ASSOCIATION WORKGROUPS; DIAGNOSTIC GUIDELINES; NATIONAL INSTITUTE; DOUBLE-BLIND; HYPERTENSION; PREVENTION; DISEASE; PLACEBO; AGE;

D O I：

10.1001/jama.2018.21442

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：553 / 561

页数：9

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