SPRINT-MIND
Trial question
What is the effect of intensive BP control to reduce the risk of probable dementia in ambulatory adults with hypertension who were at an increased risk of CVD?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 9361
9361 patients (3332 female, 6029 male).
Inclusion criteria: ambulatory adult patients (≥ 50 years of age) with hypertension but without diabetes or history of stroke who had an increased cardiovascular risk.
Key exclusion criteria: nursing home residents, diagnosis of dementia, use of dementia therapy medications, diabetes mellitus, history of stroke.
Interventions
N=4678 intensive BP reduction (SBP goal of < 120 mmHg with antihypertensives).
N=4683 standard BP management (systemic BP goal of < 140 mmHg with antihypertensive medications).
Primary outcome
Incidence of adjudicated probable dementia at a median follow-up of 5.11 years
7.2
8.6
8.6/1000 py
6.4/1000 py
4.3/1000 py
2.1/1000 py
0.0/1000 py
Intensive blood pressure
reduction
Standard blood pressure
management
No significant
difference ↔
No significant difference in the incidence of adjudicated probable dementia at a median follow-up of 5.11 years (7.2/1000 py vs. 8.6/1000 py; HR 0.83, 95% CI 0.67 to 1.04).
Secondary outcomes
Significant decrease in the incidence of MCI (14.6/1000 py vs. 18.3/1000 py; HR 0.81, 95% CI 0.69 to 0.95).
Significant decrease in MCI or probable dementia (20.2 vs. 24.1; HR 0.85, 95% CI 0.74 to 0.97).
Safety outcomes
No significant difference in interaction between treatment group and prespecified subgroups with respect to the composite of MCI and probable dementia.
Conclusion
In ambulatory adult patients (≥ 50 years of age) with hypertension but without diabetes or history of stroke who had an increased cardiovascular risk, intensive BP reduction was not superior to standard BP management with respect to the incidence of adjudicated probable dementia at a median follow-up of 5.11 years.
Reference
SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):553-561.
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