Effects of intensive versus standard blood pressure control on domain-specific cognitive function: a substudy of the SPRINT randomised controlled trial

被引:66
作者
Rapp, Stephen R. [1 ]
Gaussoin, Sarah A. [2 ]
Sachs, Bonnie C. [3 ]
Chelune, Gordon [5 ]
Supiano, Mark A. [7 ,8 ]
Lerner, Alan J. [9 ]
Wadley, Virginia G. [10 ]
Wilson, Valarie M. [4 ]
Fine, Lawrence J. [11 ]
Whittle, Jeff C. [12 ,13 ]
Auchus, Alexander P. [14 ]
Beddhu, Srinivasan [7 ,8 ]
Berlowitz, Dan R. [15 ,16 ]
Bress, Adam P. [6 ]
Johnson, Karen C. [17 ]
Krousel-Wood, Marie [18 ,19 ,20 ]
Martindale-Adams, Jennifer [17 ]
Miller, Eliza C. [21 ]
Rifkin, Dena E. [22 ]
Snyder, Joni K. [11 ]
Tamariz, Leonardo [23 ,24 ]
Wolfgram, Dawn F. [12 ,13 ]
Cleveland, Maryjo L. [4 ]
Yang, Mia [4 ]
Nichols, Linda O. [25 ]
Bryan, Robert Nick [26 ]
Reboussin, David M. [2 ]
Williamson, Jeff D. [4 ]
Pajewski, Nicholas M. [2 ]
机构
[1] Wake Forest Sch Med, Dept Psychiat & Behav Med, Winston Salem, NC 27157 USA
[2] Wake Forest Sch Med, Dept Biostat & Data Sci, Winston Salem, NC 27157 USA
[3] Wake Forest Sch Med, Dept Neurol, Winston Salem, NC 27157 USA
[4] Wake Forest Sch Med, Dept Internal Med, Winston Salem, NC 27157 USA
[5] Univ Utah, Sch Med, Dept Neurol, Salt Lake City, UT USA
[6] Univ Utah, Sch Med, Dept Populat Hlth Sci, Salt Lake City, UT USA
[7] Univ Utah, Sch Med, Dept Internal Med, Salt Lake City, UT USA
[8] Vet Affairs Salt Lake City Hlth Care Syst, Salt Lake City, UT USA
[9] Case Western Reserve Univ, Sch Med, Dept Neurol, Cleveland, OH 44106 USA
[10] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA
[11] NHLBI, Clin Applicat & Prevent Branch, Bldg 10, Bethesda, MD 20892 USA
[12] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA
[13] Clement J Zablocki Vet Affairs Med Ctr, Milwaukee, WI USA
[14] Univ Mississippi, Med Ctr, Dept Neurol, Jackson, MS 39216 USA
[15] Bedford Vet Affairs Med Ctr, Bedford, MA USA
[16] Univ Massachusetts Lowell, Dept Publ Hlth, Lowell, MA USA
[17] Univ Tennessee, Dept Prevent Med, Hlth Sci Ctr, Memphis, TN USA
[18] Tulane Univ, Dept Med, New Orleans, LA 70118 USA
[19] Tulane Univ, Dept Epidemiol, New Orleans, LA 70118 USA
[20] Ochsner Hlth Syst, New Orleans, LA USA
[21] Columbia Univ, Coll Phys & Surg, Dept Neurol, New York, NY USA
[22] Univ Calif San Diego, Div Nephrol Hypertens, La Jolla, CA 92093 USA
[23] Miami Vet Affairs Healthcare Syst, Miami, FL USA
[24] Univ Miami, Div Populat Hlth & Computat Med, Miami, FL USA
[25] Vet Affairs Med Ctr, Prevent Med Sect, Memphis, TN USA
[26] Univ Texas Austin, Dell Med Sch, Dept Diagnost Med, Austin, TX 78712 USA
基金
美国国家卫生研究院;
关键词
DEMENTIA; RISK; HYPERTENSION; PREVENTION; DISEASE;
D O I
10.1016/S1474-4422(20)30319-7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Results from the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive control of systolic blood pressure significantly reduced the occurrence of mild cognitive impairment, but not probable dementia. We investigated the effects of intensive lowering of systolic blood pressure on specific cognitive functions in a preplanned substudy of participants from SPRINT. Methods SPRINT was an open-label, multicentre, randomised controlled trial undertaken at 102 sites, including academic medical centres, Veterans Affairs medical centres, hospitals, and independent clinics, in the USA and Puerto Rico. Participants were adults aged 50 years or older with systolic blood pressure higher than 130 mm Hg, but without diabetes, history of stroke, or dementia. Participants were randomly assigned (1:1) to a systolic blood pressure goal of less than 120 mm Hg (intensive treatment) versus less than 140 mm Hg (standard treatment). All major classes of antihypertensive agents were included. A subgroup of randomly assigned participants including, but not limited to, participants enrolled in an MRI substudy was then selected for a concurrent substudy of cognitive function (target 2800 participants). Each individual was assessed with a screening cognitive test battery and an extended cognitive test battery at baseline and biennially during the planned 4-year follow-up. The primary outcomes for this substudy were standardised composite scores for memory (Logical Memory I and II, Modified Rey-Osterrieth Complex Figure [immediate recall], and Hopkins Verbal Learning Test-Revised [delayed recall]) and processing speed (Trail Making Test and Digit Symbol Coding). SPRINT was registered with ClinicalTrials.gov, NCT01206062. Findings From Nov 23, 2010, to Dec 28, 2012, 2921 participants (mean age 68.4 years [SD 8.6], 1080 [37%] women) who had been randomly assigned in SPRINT were enrolled in the substudy (1448 received intensive treatment and 1473 received standard treatment). SPRINT was terminated early due to benefit observed in the primary outcome (composite of cardiovascular events). After a median follow-up of 4.1 years (IQR 3.7-5.8), there was no between-group difference in memory, with an annual decline in mean standardised domain score of -0.005 (95% CI -0.010 to 0.001) in the intensive treatment group and -0.001 (-0.006 to 0.005) in the standard treatment group (between-group difference -0.004, 95% CI -0.012 to 0.004; p=0.33). Mean standardised processing speed domain scores declined more in the intensive treatment group (between-group difference -0.010, 95% CI -0.017 to -0.002; p=0.02), with an annual decline of -0.025 (-0.030 to -0.019) for the intensive treatment group and -0.015 (-0.021 to 0.009) for the standard treatment group. Interpretation Intensive treatment to lower systolic blood pressure did not result in a clinically relevant difference compared with standard treatment in memory or processing speed in a subgroup of participants from SPRINT. The effect of blood pressure lowering might not be evident in specific domains of cognitive function, but instead distributed across multiple domains.
引用
收藏
页码:899 / 907
页数:9
相关论文
共 32 条
[1]   White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities [J].
Alber, Jessica ;
Alladi, Suvarna ;
Bae, Hee-Joon ;
Barton, David A. ;
Beckett, Laurel A. ;
Bell, Joanne M. ;
Berman, Sara E. ;
Biessels, Geert Jan ;
Black, Sandra E. ;
Bos, Isabelle ;
Bowman, Gene L. ;
Brai, Emanuele ;
Brickman, Adam M. ;
Callahan, Brandy L. ;
Corriveau, Roderick A. ;
Fossati, Silvia ;
Gottesman, Rebecca F. ;
Gustafson, Deborah R. ;
Hachinski, Vladimir ;
Hayden, Kathleen M. ;
Helman, Alex M. ;
Hughes, Timothy M. ;
Isaacs, Jeremy D. ;
Jefferson, Angela L. ;
Johnson, Sterling C. ;
Kapasi, Alifiya ;
Kern, Silke ;
Kwon, Jay C. ;
Kukolja, Juraj ;
Lee, Athene ;
Lockhart, Samuel N. ;
Murray, Anne ;
Osborn, Katie E. ;
Power, Melinda C. ;
Price, Brittani R. ;
Rhodius-Meester, Hanneke F. M. ;
Rondeau, Jacqueline A. ;
Rosen, Allyson C. ;
Rosene, Douglas L. ;
Schneider, Julie A. ;
Scholtzova, Henrieta ;
Shaaban, C. Elizabeth ;
Silva, Narlon C. B. S. ;
Snyder, Heather M. ;
Swardfager, Walter ;
Troen, Aron M. ;
van Veluw, Susanne J. ;
Vemuri, Prashanthi ;
Wallin, Anders ;
Wellington, Cheryl .
ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS, 2019, 5 (01) :107-117
[2]   The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: The Systolic Blood Pressure Intervention Trial (SPRINT) [J].
Ambrosius, Walter T. ;
Sink, Kaycee M. ;
Foy, Capri G. ;
Berlowitz, Dan R. ;
Cheung, Alfred K. ;
Cushman, William C. ;
Fine, Lawrence J. ;
Goff, David C., Jr. ;
Johnson, Karen C. ;
Killeen, Anthony A. ;
Lewis, Cora E. ;
Oparil, Suzanne ;
Reboussin, David M. ;
Rocco, Michael V. ;
Snyder, Joni K. ;
Williamson, Jeff D. ;
Wright, Jackson T., Jr. ;
Whelton, Paul K. .
CLINICAL TRIALS, 2014, 11 (05) :532-546
[3]  
[Anonymous], 1983, Boston diagnostic aphasia examination booklet
[4]  
[Anonymous], 1997, Wechsler Memory Scale-Third Edition: Administration and scoring manual
[5]   NORMAL RATES OF FORGETTING OF VERBAL AND NONVERBAL MATERIAL IN ALZHEIMERS-DISEASE [J].
BECKER, JT ;
BOLLER, F ;
SAXTON, J ;
MCGONIGLEGIBSON, KL .
CORTEX, 1987, 23 (01) :59-72
[6]   Hopkins Verbal Learning Test Revised: Normative data and analysis of inter-form and test-retest reliability [J].
Benedict, RHB ;
Schretlen, D ;
Groninger, L ;
Brandt, J .
CLINICAL NEUROPSYCHOLOGIST, 1998, 12 (01) :43-55
[7]  
Benjamin EJ, 2017, CIRCULATION, V135, pE146, DOI [10.1161/CIR.0000000000000485, 10.1161/CIR.0000000000000558, 10.1161/CIR.0000000000000530]
[8]   Cognitive function and hypertension [J].
Birns, J. ;
Kalra, L. .
JOURNAL OF HUMAN HYPERTENSION, 2009, 23 (02) :86-96
[9]   The effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials [J].
Birns, Jonathan ;
Morris, Robin ;
Donaldson, Nora ;
Kalra, Lalit .
JOURNAL OF HYPERTENSION, 2006, 24 (10) :1907-1914
[10]   Effects of blood pressure and lipid lowering on cognition Results from the HOPE-3 study [J].
Bosch, Jackie ;
O'Donnell, Martin ;
Swaminathan, Balakumar ;
Lonn, Eva Marie ;
Sharma, Mikul ;
Dagenais, Gilles ;
Diaz, Rafael ;
Khunti, Kamlesh ;
Lewis, Basil S. ;
Avezum, Alvaro ;
Held, Claes ;
Keltai, Matyas ;
Reid, Christopher ;
Toff, William D. ;
Dans, Antonio ;
Leiter, Lawrence A. ;
Sliwa, Karen ;
Lee, Shun Fu ;
Pogue, Janice M. ;
Hart, Robert ;
Yusuf, Salim .
NEUROLOGY, 2019, 92 (13) :E1435-E1446