Researchers at the University of Tennessee Health Science Center and the Memphis Veterans Affairs (VA) Medical Center were part of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition IN Decreased Hypertension) multisite clinical trial, which today released data showing aggressively lowering blood pressure reduces the risk of mild cognitive impairment (MCI) and a combination of MCI and dementia.
The findings were presented at the Alzheimer’s Association International Conference in Chicago.
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) was the primary sponsor of the SPRINT study, which started in the fall of 2009 and included more than 9,300 participants age 50 and older with hypertension who were at increased risk for cardiovascular disease. They were recruited from approximately 100 medical centers and clinical practices throughout the United States and Puerto Rico.
In Memphis, UTHSC was a large SPRINT study site following 175 participants since the study launched. Karen C. Johnson, MD, MPH, College of Medicine Endowed Professor in Women’s Health and professor of Preventive Medicine at UTHSC, is the principal investigator for the UTHSC SPRINT study site. Dr. Johnson is also the national vice chair of the SPRINT Steering Committee.
The Memphis VA Medical Center, also a SPRINT study site, entered 1,660 participants at 25 VA medical centers within the SPRINT Veterans Affairs Clinical Center Network (CCN). William Cushman, MD, chief of Preventive Medicine at the Memphis VA and professor of Preventive Medicine, Medicine, and Physiology at UTHSC, serves as the principal investigator for the VA Network. Dr. Barry Wall, also from the Memphis VA, is the co-principal investigator for the SPRINT VA Clinical Center Network and principal investigator for the VA Memphis SPRINT clinical site that recruited 80 veterans for SPRINT. Linda Nichols PhD, professor, and Jennifer Martindale-Adams, EdD, associate professor in the Department of Preventive Medicine at UTHSC, are also VA CCN consultants for the SPRINT MIND study.
“To date, the results of SPRINT MIND provide the strongest evidence that by aggressively treating high blood pressure, there is a reduced risk of developing MCI or dementia,” Dr. Johnson said.
In SPRINT MIND, the researchers found a 19 percent lower rate of new cases of MCI in the intensive blood pressure treatment group, where the systolic blood pressure goal was less than 120 mm Hg. The combined outcome of MCI plus probable all-cause dementia was also 15 percent lower in the intensive treatment group versus the standard blood pressure group. The new SPRINT MIND findings provide promise that individuals can take steps to lower their risk of mild cognitive impairment and dementia, and it could be as easy as lowering their systolic blood pressure levels.
“Getting busy clinicians to get to a lower blood pressure goal will require the patient and all the members of the health care team contributing,” said Catherine Womack, MD, a SPRINT co-investigator and interim chair of the Department of Preventive Medicine and co-chief of the Division of Internal Medicine in the College of Medicine at UTHSC. “We were able to get patients to goal in SPRINT because we focused on an algorithm that required adjustment of blood pressure medications, if the individual participant was not at goal. As a result, the physician and the hypertensive patient will need to work together with regular visits to meet the lower target.”
Previous data from SPRINT has already had a world-wide impact on how people define hypertension and how doctors treat hypertension, with new blood pressure guidelines published by the American College of Cardiology and the American Heart Association in 2017.
“These results are promising in that there is strong evidence that there are things you can do that lower cardiovascular disease risk that will also reduce your risk of MCI and dementia,” Dr. Cushman said.
SPRINT MIND MRI Results
In a related abstract, preliminary results from 673 participants in SPRINT MIND, who were recruited for brain magnetic resonance imaging (MRI), were also reported. In this sub-study, white matter lesion volume increased in both treatment groups; however, the increase was significantly less in the intensive treatment group. White matter lesions are frequently indicative of small vessel disease in the brain and are linked to higher risk of stroke, dementia, and higher mortality. The SPRINT MIND MRI study suggests that intensive systolic blood pressure lowering to a treatment goal of less than 120 mm Hg may reduce the risk of physical changes in the brain that are associated with dementia.