Williamson JD, et al. - In this randomized clinical trial, researchers assessed the impact on the rate of probable dementia and mild cognitive impairment of intensive BP control (systolic blood pressure [SBP] target <120 mm Hg) compared to the standard SBP treatment goal of less than 140 mm Hg. According to findings, treating to SBP goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not lead to a significant reduction in the risk of probable dementia in ambulatory adults with hypertension. Due to the early termination of the study and fewer cases of dementia than expected, the study may have been underpowered for this endpoint.

Methods

• This trial conducted at 102 sites in the United States and Puerto Rico among adults (aged 50 years or older) with hypertension but without diabetes or history of stroke.
• On November 8, 2010, randomisation began.
• On August 20, 2015, the trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality.
• The final follow-up date for cognitive results was July 22, 2018.
• Participants in the study were randomized to a SBP goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683).
• Occurrence of adjudicated probable dementia was the primary cognitive outcome.
• Adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia were included secondary cognitive outcomes.

Results

• Of the 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment.
• Data reported that the median intervention period was 3.34 years.
• Adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67-1.04) during a total median follow-up of 5.11 years.
• Investigators observed that intensive BP control reduced significantly the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97).