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Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial.
Hypertension. 2023 08; 80(8):1628-1636.H

Abstract

BACKGROUND

The prognostic value of systolic blood pressure (SBP) time in target range (TTR) on cognitive outcomes among adults with hypertension remains unclear.

METHODS

We performed secondary analysis of SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension), which compared intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP intervention in hypertensive individuals. TTR was calculated from baseline to month 3 using 110 to 130 mm Hg and 120 to 140 mm Hg as target range for the intensive and standard groups, respectively. Cognitive outcomes included probable dementia, mild cognitive impairment, and the composite of probable dementia or mild cognitive impairment. Cox regression models were used to evaluate the relationship between SBP-TTR and cognitive outcomes.

RESULTS

A total of 8298 patients were included. Participants with higher TTR were younger and less likely to be women or to have a history of cardiovascular disease. After adjustment of baseline demographics, medical history, and mean SBP, a 1-SD (31.5%) increase in TTR was independently associated with a 14% lower risk of probable dementia (hazard ratio, 0.86 [95% CI, 0.76-0.98]; P=0.023). Sensitivity analysis showed consistent results when combining target range as 110 to 140 mm Hg. However, there was no significant association between SBP-TTR and mild cognitive impairment.

CONCLUSIONS

In this post hoc analysis of SPRINT MIND, SBP-TTR was an independent predictor of probable dementia beyond mean SBP. Maintaining SBP within 110 to 140 mm Hg over time may be beneficial for dementia prevention.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT01206062.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Li S
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Jiang C
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Wang Y
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Lai Y
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Zhao M
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Li Q
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Bai Y
School of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (Y.B.).
Dai W
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Guo Q
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
He L
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Guo X
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Wang W
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Li S
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Liu N
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Jiang C
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Tang R
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Sang C
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Long D
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).
Du X
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.). Heart Health Research Center, Beijing, China (X.D., C.S.A.).
Dong J
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.). Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.).
Anderson CS
Heart Health Research Center, Beijing, China (X.D., C.S.A.). Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Australia (C.S.A.). Faculty of Medicine, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.).
Ma C
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China (Sitong Li, Chao Jiang, Y.W., Y.L., M.Z., Q.L., W.D., Q.G., L.H., X.G., W.W., Songnan Li, N.L., Chenxi Jiang, R.T., C.S., D.L., X.D., J.D., C.M.).

MeSH

HumansFemaleMaleBlood PressureAntihypertensive AgentsHypertensionCognitionDementiaRisk Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

37165869

Clinical Trial Links

Clinical trial which this article describes

Citation

Li, Sitong, et al. "Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial." Hypertension (Dallas, Tex. : 1979), vol. 80, no. 8, 2023, pp. 1628-1636.
Li S, Jiang C, Wang Y, et al. Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial. Hypertension. 2023;80(8):1628-1636.
Li, S., Jiang, C., Wang, Y., Lai, Y., Zhao, M., Li, Q., Bai, Y., Dai, W., Guo, Q., He, L., Guo, X., Wang, W., Li, S., Liu, N., Jiang, C., Tang, R., Sang, C., Long, D., Du, X., ... Ma, C. (2023). Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial. Hypertension (Dallas, Tex. : 1979), 80(8), 1628-1636. https://doi.org/10.1161/HYPERTENSIONAHA.122.20711
Li S, et al. Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial. Hypertension. 2023;80(8):1628-1636. PubMed PMID: 37165869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT MIND Trial. AU - Li,Sitong, AU - Jiang,Chao, AU - Wang,Yufeng, AU - Lai,Yiwei, AU - Zhao,Manlin, AU - Li,Qifan, AU - Bai,Yu, AU - Dai,Wenli, AU - Guo,Qi, AU - He,Liu, AU - Guo,Xueyuan, AU - Wang,Wei, AU - Li,Songnan, AU - Liu,Nian, AU - Jiang,Chenxi, AU - Tang,Ribo, AU - Sang,Caihua, AU - Long,Deyong, AU - Du,Xin, AU - Dong,Jianzeng, AU - Anderson,Craig S, AU - Ma,Changsheng, Y1 - 2023/05/11/ PY - 2023/7/21/medline PY - 2023/5/11/pubmed PY - 2023/5/11/entrez KW - cognition KW - cognitive dysfunction KW - dementia KW - hypertension KW - time in target range SP - 1628 EP - 1636 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 80 IS - 8 N2 - BACKGROUND: The prognostic value of systolic blood pressure (SBP) time in target range (TTR) on cognitive outcomes among adults with hypertension remains unclear. METHODS: We performed secondary analysis of SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension), which compared intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP intervention in hypertensive individuals. TTR was calculated from baseline to month 3 using 110 to 130 mm Hg and 120 to 140 mm Hg as target range for the intensive and standard groups, respectively. Cognitive outcomes included probable dementia, mild cognitive impairment, and the composite of probable dementia or mild cognitive impairment. Cox regression models were used to evaluate the relationship between SBP-TTR and cognitive outcomes. RESULTS: A total of 8298 patients were included. Participants with higher TTR were younger and less likely to be women or to have a history of cardiovascular disease. After adjustment of baseline demographics, medical history, and mean SBP, a 1-SD (31.5%) increase in TTR was independently associated with a 14% lower risk of probable dementia (hazard ratio, 0.86 [95% CI, 0.76-0.98]; P=0.023). Sensitivity analysis showed consistent results when combining target range as 110 to 140 mm Hg. However, there was no significant association between SBP-TTR and mild cognitive impairment. CONCLUSIONS: In this post hoc analysis of SPRINT MIND, SBP-TTR was an independent predictor of probable dementia beyond mean SBP. Maintaining SBP within 110 to 140 mm Hg over time may be beneficial for dementia prevention. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01206062. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/37165869/Systolic_Blood_Pressure_Time_in_Target_Range_and_Cognitive_Outcomes:_Insights_From_the_SPRINT_MIND_Trial_ DB - PRIME DP - Unbound Medicine ER -