Thursday , February 25 2021

The new important study finds lowering blood pressure to prevent cognitive decline, but questions remain



Photo: Adam Berry (Getty Images)

Some millions of Americans live with dementia, most of Alzheimer's disease. And it is almost certain that as the general population ages, dementia will be more frequent. But a new study published this week offers encouraging news, if it is mixed.

It could be possible to prevent cognitive decline by aggressively treating high blood pressure from a person, found the study. Unfortunately, it is not clear if decreasing blood pressure can do the same for dementia.

A project known as a systolic blood pressure intervention, or SPRINT, was initiated in 2010. He recruited about 10,000 volunteers over 50 years old with hypertension and at least one other risk factor for cardiovascular diseases, such as smoking. The trial was to compare if trying to reduce systolic blood pressure (the maximum number in blood pressure reading) below 120 would be better for the general health of people than to try to reduce it to 140. This last threshold was, at this time, considered standard care.

Cardiovascular disease was the main health outcome examined by the SPRINT study, which ended in early 2015, after it appeared that the goal of 120 was better to prevent such things as heart attacks and Cerebral spills that are standard care. But also a subgroup of about 8,500 volunteers was studied for their possible risk of dementia and mild cognitive impairment (MCI), an earlier stage of memory loss and brain drain that often advances towards dementia.

The conclusions of the current study, published on Monday at JAMA, come from this parallel project, called the SPRINT MIND study. He found that, aggressively, relatively healthy people had a significant likelihood of developing MCI than those who received standard care. The rate of new MCI cases was 19% lower in this group.

High blood pressure is a risk factor for all types of conditions, including cognitive decline. But while scientists largely accept that keeping blood pressure in sight should help prevent dementia, we currently do not have specific tests in human trials that any potential intervention can reduce dementia rates. So the results of SPRINT MIND are definitely good news in this regard.

But there is also a great warning for the study. In short, while there was a small reduction in the new cases of full dementia in the aggressive treatment group, it was not a statistically significant difference from the group given the standard care. In other words, the study did not achieve its primary outcome.

Normally, it is easy to reject the results offered by the SPRINT MIND studio as an overflowing hype. But there is a key point to keep in mind. Although not all people with MCI continue to develop dementia, all people with dementia will experience MCI. And because the study was finished before the hour, it is possible that researchers simply do not have the time to detect a real reduction in cases of dementia.

"The fact that there is still a MCI result when the study is reduced makes these results encouraging," said Laurie Ryan, head of the Institute for Aging Dementia Section National about Aging, in a statement (the NIH helped finance the original SPRINT Study).

Thus, while the study is not a home for the prevention of dementia, it is a promising advantage. In light of the results, the Alzheimer's Association announced Monday that it would help finance SPRINT MIND 2.0, an extension of the original study that should provide two more years of follow-up.

"The Association of Alzheimer's believes that these data are convincing and promises to obtain clarity and certainty about the result of dementia by the following participants during a longer period," said Maria Carrillo in a statement , a scientific officer at the Alzheimer's Association.

Luckily, time will really tell if lowering blood pressure can prevent dementia.

[JAMA via NIH, Alzheimer’s Association]

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