S-02-3: A REVIEW AND NEW INSIGHTS FROM THE SPRINT MIND TRIAL DATA

Abstract

Background: Proven treatments for reducing the risk of mild cognitive impairment (MCI) and dementia have been lacking. The impact of intensive treatment of hypertension on the incidence of Mild Cognitive Impairment (MCI) and dementia was tested in the Systolic Blood Pressure Intervention Trial (SPRINT-MIND) by prospectively assessing the effect of intensive blood pressure control to a target systolic blood pressure of <120 mmHg versus a standard target (<140 mmHg). This presentation reviews the SPRINT results demonstrating a reduction in risk of developing dementia and MCI and presents additional data on the reliability of the MCI and dementia diagnosis. We will also provide preliminary evidence for differential cognitive benefit from specific antihypertensive medicines and evidence for lack of benefit after onset of cognitive impairment Results: At one year, mean systolic blood pressure was 121.4 mmHg in the intensive-treatment group and 136.2 mmHg in the standard-treatment group. Treatment was stopped on 8/20/2015 due to CVD benefit after a median follow up of 3.26 years, but cognitive assessment continued. Participant mean age was 67.9 years (35.6% women) and 8,626 (92.1%) completed at least one follow-up cognitive assessment. There was a significantly lower rate of adjudicated incident MCI (HR 0.81, CI 0.67–0.97) and a non-significant reduction in probable dementia (HR 0.83, CI 0.69–1.04). The combined outcome of MCI plus probable all cause dementia was significantly lower (HR 0.85, CI 0.74–0.97) in the intensive versus standard treatment group. Most cases occurred in persons over age 70. At 2 years, MCI classification was 10X more likely to transition to dementia than normal cognition and 30% of classified as MCI reverted to normal, consistent with other large epidemiologic studies of MCI trajectory Conclusions: Among ambulatory adults at increased risk for CVD but without diabetes, treating to a SBP target < 120 mmHg compared to a target of < 140 mmHg reduces the risk of incident MCI and combined MCI/probable dementia. Reduction of dementia risk by cardiovascular interventions is feasible in the elderly population.