Abstract 107: Effect Of Intensive Blood Pressure Control On Incident Stroke Risk In Patients With Mild Cognitive Impairment

Abstract

Background: Patients with mild cognitive impairment (MCI) are at higher risk of incident stroke, but the effect of intensive blood pressure (BP) control on that risk has not been explored. Methods: We performed a post-hoc analysis of the SPRINT trial and included patients with a baseline Montreal Cognitive Assessment (MoCA) score of 20-26 and without a prior history of stroke. The primary outcome was incident stroke (ischemic and hemorrhagic) during follow-up. We estimated the risk of our primary outcome by SPRINT randomization arm (intensive vs. standard BP control) and fit Cox models for the primary outcome, adjusting for patient age, race, sex, baseline blood pressure, atrial fibrillation, diabetes, and smoking. We also verified the proportional hazards assumption of our final model. Results: We included 5507 patients (mean age 67.8 + 9.4 years, 66.6% male, 59.5% non-Hispanic white, and 50.1% randomized to intensive BP control), of which 94/5507 (1.7%) had an incident stroke during a mean of 3.8±0.9 years of follow-up. The risk of incident stroke in patients randomized to intensive BP control was 37/2762 (1.3%) and to standard BP control was 57/2745 (2.1%). In the adjusted Cox model, the hazard ratio for incident stroke events with intensive BP control was 0.63 (95% CI 0.42-0.96, p=0.03). The Kaplan-Meier curve by randomization arm is seen in Figure 1. Conclusion: Although the SPRINT trial failed to show a reduction in stroke with intensive BP control for all subjects, those with MCI at baseline may benefit from intensive BP control to lower risk of incident stroke. Future trials of primary prevention of stroke or vascular cognitive impairment and dementia could benefit from enrichment using baseline biomarkers of elevated risk, such as mild cognitive impairment.