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MSC, a precursor of early dementia, in a clinical trial of Wake Forest School of Medicine, part of Wake Forest Baptist Health. However, the National Institutes of Health-supported Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (SPRINT MIND) study did not prove that treating blood pressure to a goal of 120 mm Hg or less statistically reduced the risk of dementia . This result may have been due to too few new cases of dementia in the study, the authors noted.
The results were reported in the Jan. 28 edition of the Journal of the American Medical Association.
MCI is defined as a decline in memory and thinking skills that is greater than expected with normal aging and is a risk factor for dementia. Dementia is defined as a group of symptoms badociated with a decline in memory or other thinking skills.
"As doctors treating older patients," said the study's principal investigator, Jeff Williamson, MD, professor of gerontology and geriatric medicine at Wake Forest School of Medicine. "In the study, we found that just three years of lower blood pressure not only dramatically helped the heart but also the brain."
The objective of SPRINT MIND was to evaluate the effect of intensive blood pressure control on the risk of dementia. Hypertension, which affects more than half of those over 75 percent of those older than 65, has been identified as having a modifiable risk factor for MCI and dementia in previous observational studies.
The clinical trial, which enrolled 9361 volunteers, was conducted at 102 sites in the United States and Puerto Rico among adults 50 and older with hypertension but without diabetes or history of stroke. The participating group was 35.6 percent female, 30 percent black, and 10.5 percent Hispanic and thus representative of the broader U.S. population.
Participants were randomly badigned to a systolic blood pressure of less than 120 mm HG (intensive treatment) or less than 140 mm HG (standard treatment). They were then clbadified after five years of having no cognitive impairment, MCI or probable dementia.
"Although the study showed a deterioration in the intensity of the controlled group, we were disappointed that the results did not achieve statistical significance for this outcome," Williamson said. "Last week the Alzheimer's Association agreed to fund additional follow-up of SPRINT MIND participants in the hope that sufficient dementia cases will be increased, allowing for a more definitive statement on these outcomes."
SPRINT was stopped early in the course of the trial of reducing cardiovascular disease. As a result, participants were on intensive blood pressure lowering treatment for a shorter period than originally planned. The authors concluded that the short time may have made it difficult to accurately determine the role of intensive blood pressure control on dementia cases.
Williamson said some caution should be exercised in the interpretation of the study result because it is important to understand the impact of the trial. Although it is certainly increasing the risk of dementia, this progression is not inevitable and reversion to normal cognition is possible, he said.
HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and HHSN268200900047C, HHSN268200900048C and HHSN268200900049C, and HHSN268200900047C. Clinical trial number: NCT01206062.
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Materials provided by Wake Forest Baptist Medical Center. Note: Content can be edited for style and length.
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