Skip to main content
SpringerLink
Log in

The Effects of Lower BP Goals on Cognitive Function in the Elderly

  • Hypertension (DS Geller and DL Cohen, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the research on the impact of blood pressure control on prevention of cognitive impairment and dementia.

Recent Findings

Observational evidence has shown an association between hypertension and cognitive impairment. However, clinical trial results of blood pressure lowering have been inconclusive, likely due to inadequate cognitive assessment, blood pressure difference between groups, and follow-up duration. SPRINT-MIND showed a 19% reduction in mild cognitive impairment (14.6 vs 18.3 per 1000 person-years; HR, 0.81; 95% CI, 0.67–0.95), the earliest manifestation of dementia, with intensive blood pressure control. There was a statistically non-significant 17% reduction in the risk of probable dementia (HR 0.83, 95% CI 0.67–1.04).

Summary

The progress of clinical trials testing the impact of blood pressure reduction on cardiovascular disease incidence has helped inform large trial testing of this intervention’s impact on cognitive decline and dementia. SPRINT MIND demonstrated a positive effect of intensive blood pressure control on risk for mild cognitive impairment (MCI), and though the effect size was similar to MCI, the result was statistically non-significant possibly due to early termination of the intervention. Extension of follow-up may increase the number of new cases of dementia, producing a more conclusive result for dementia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Matthews K, Xu W, Gaglioti A, Holt JB, Croft D, Mack D, et al. Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015-2060)in Adults aged ≥ 65 years. Alzheimers Dement. 2019(15):17–24. https://doi.org/10.1016/j.jalz.2018.06.3063.

  2. Promoting Health for Older Adults [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2019 [cited 2020Jan6]. Available from: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm

  3. Birks JS. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006. https://doi.org/10.1002/14651858.CD003154.pub5.

  4. Black SE, Doody R, Li H, McRae T, Jambor KM, Xu Y, et al. Donepezil preserves cognition and global function in patients with severe Alzheimer disease. Neurology. 2007;69:459. https://doi.org/10.1212/01.wnl.0000266627.96040.5a.

    Article  CAS  PubMed  Google Scholar 

  5. Burns A, Bernaei R, Bullock R, Cruz Jentoft AJ, Frolich L, Hock C, et al. Safety and efficacy of Galantamine (Reminyl) in severe Alzheimer’s disease ( the SERAD study): a randomized, placebo-controlled, double-blind trial. Lancet Neurol. 2009;8:39–47. https://doi.org/10.1016/S1474-4422(08)70261-8.

    Article  CAS  PubMed  Google Scholar 

  6. Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Mobius HJ, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003;348:1333–41. https://doi.org/10.1056/NEJMoa013128.

    Article  CAS  PubMed  Google Scholar 

  7. McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev. 2006;2:CD003154.

    Google Scholar 

  8. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med. 2010;362:1173–80. https://doi.org/10.1056/NEJMoa0909087.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–38. https://doi.org/10.1056/NEJMoa0902234.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Isaac MG, Quinn R, Tabet N. Vitamin E for Alzheimer’s disease and mild cognitive impairment. Cochrane Database Syst Rev. 2008. https://doi.org/10.1002/14651858.CD002854.pub5.

  11. Schneider LS, Dekosky ST, Farlow MR, Tarriot PN, Hoerr R, Kieser M. A randomized, double-blind, placebo-controlled trial of two doses of ginkgo Biloba extract in dementia of the Alzheimer’s type. Curr Alzheimer Res. 2005;2:541–51. https://doi.org/10.2174/156720505774932287.

    Article  CAS  PubMed  Google Scholar 

  12. Feldman HH, Doody RS, Kivipelto M, Sparks DL, Waters DD, Jones RW, et al. Randomized control trial of atorvastatin in mild to moderate Alzheimer disease: LEADe. Neurology. 2010;74:956–64. https://doi.org/10.1212/WNL.0b013e3181d6476a.

    Article  CAS  PubMed  Google Scholar 

  13. Gottesman RF, Schneider AL, Zhou Y, Coresh J, Green E, Gupta N, et al. Association between midlife vascular risk factors and estimated brain amyloid deposition. JAMA. 2017;317:1443–50. https://doi.org/10.1001/jama.2017.3090.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Whitmer RA, Sidney S, Selby J, Johnston SC, Yaffe K. Midlife cardiovascular factors and risk of dementia in late life. Neurology. 2005;64:277–81. https://doi.org/10.1212/01.WNL.0000149519.47454.F2.

    Article  CAS  PubMed  Google Scholar 

  15. Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA. 1995;274:1846–51. https://doi.org/10.1001/jama.1995.03530230032026.

    Article  CAS  PubMed  Google Scholar 

  16. Gelber RP, Launer LJ, White LR. The Honolulu-Asia aging study: epidemiologic and neuropathologic research on cognitive impairment. Curr Alzheimer Res. 2012;6:664–72. https://doi.org/10.2174/156720512801322618.

    Article  Google Scholar 

  17. Freitag M, Peila R, Masaki K, Petrovich H, Ross GW, White LR, et al. Midlife pulse pressure and incidence of dementia: the Honolulu Asia aging study. Stroke. 2006;37:33–7. https://doi.org/10.1161/01.STR.0000196941.58869.2d.

    Article  PubMed  Google Scholar 

  18. Guo Z, Fratiglioni L, Winblad B, Viitnen M. Blood pressure and performance on the mini-mental state examination in the very old. Cross-sectional and longitudinal data from the Kungsholmen project. Am J Epidemiol. 1997;145:1106–13. https://doi.org/10.1093/oxfordjournals.aje.a009073.

    Article  CAS  PubMed  Google Scholar 

  19. James P, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. A report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA. 2014;311:507–20. https://doi.org/10.1001/jama.2013.284427.

    Article  CAS  PubMed  Google Scholar 

  20. McGuinness B, Todd S, Passmore P, Bullock R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev. 2009. https://doi.org/10.1002/14651858.CD004034.pub3.

  21. Peters R, Beckett N, Forette F, Tuomilehto CR, Ritchie C, et al. Incident dementia and blood pressure lowering in the hypertension in the very elderly trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7:683–9. https://doi.org/10.1016/S1474-4422(08)70143-1.

    Article  CAS  PubMed  Google Scholar 

  22. Tzourio C, Anderson C, Chapman N, Woodward M, Neal B, MacMahon S, et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;169:1069–75. https://doi.org/10.1001/archinte.163.9.1069.

    Article  Google Scholar 

  23. Anderson C, Teo K, Gao P, Arima H, Dans A, Unger T, et al. Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease; analysis of data from the ONTARGET and TRANSCEND studies. Lancet Neurol. 2011;10:43–53. https://doi.org/10.1016/S1474-4422(10)70250-7.

    Article  CAS  PubMed  Google Scholar 

  24. Van Middelaar T, van Vught L, van Gool W, Simons EMF, van den Born BH, Moll van Charante EP, et al. Blood pressure-lowering interventions to prevent dementia: a systematic review and meta-analysis. J Hypertens. 2018;36:1780–7. https://doi.org/10.1097/HJH.0000000000001829.

    Article  CAS  PubMed  Google Scholar 

  25. Elias MF, Torres RV, Davey A. Clinical trials of blood pressure lowering and antihypertensive medication: is cognitive measurement state-of-the-art? Am J Hypertens. 2018;31:631–42.

    Article  Google Scholar 

  26. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183–94.

    Article  CAS  Google Scholar 

  27. Tifratene K, Robert P, Metelkina A, Pradier C, Dartiques JF. Progression of mild cognitive impairment to dementia due to AD in clinical setting. Neurology. 2015;85:331–8. https://doi.org/10.1212/WNL.0000000000001788.

    Article  PubMed  Google Scholar 

  28. The Sprint Research Group, Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015;373:2103–16. https://doi.org/10.1056/NEJMoa1511939.

    Article  CAS  PubMed Central  Google Scholar 

  29. Williamson JD, Supiano MA, Applegate WB, Bertwitz DR, Campbell RC, Chertow GM, et al. Intensive vs standard blood pressure control and cardiovascular outcomes in adults aged ≥ 75 years. A randomized clinical trial. JAMA. 2016;315:2673–82. https://doi.org/10.1001/jama.2016.7050.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. •• The Sprint Research Group, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, et al. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019;321:553–61. https://doi.org/10.1001/jama.2018.21442Findings suggest cognitive benefit with intensive BP control. Compared with standard BP control (targeted SBP of 140 mmHg) treating to a targeted SBP of 120 mmHg resulted in a statistically significant 19% reduction in mild cognitive impairment and a non-significant 17% reduction in probable dementia.

    Article  Google Scholar 

  31. • The SPRINT MIND Investigators, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, et al. Association of intensive vs standard blood pressure control with cerebral white matter lesions. JAMA. 2019;322:524–34. https://doi.org/10.1001/jama.2019.10551Brain imaging in this substudy of SPRINT suggests neuroprotective effect of intensive BP control with smaller increases in cerebral white matter lesion volume in study participants treated to a targeted SBP of 120 mmHg compared to standard blood pressure control with targeted SBP of 140 mmHg.

    Article  Google Scholar 

  32. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force in Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–248.

Download references

Acknowledgments

We wish to thank Teresa Harnish for her assistance in preparing this manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Zeke Zamora & Jeff D. Williamson

Authors
  1. Zeke Zamora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeff D. Williamson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zeke Zamora.

Ethics declarations

Conflict of Interest

Zeke Zamora and Jeff D. Williamson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This is a review article and therefore no primary results are included that pertain to the Human Informed Consent Rights. However, all participants in the SPRINT Trial provided informed consent.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Hypertension

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zamora, Z., Williamson, J.D. The Effects of Lower BP Goals on Cognitive Function in the Elderly. Curr Cardiol Rep 22, 63 (2020). https://doi.org/10.1007/s11886-020-01312-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-020-01312-2

Keywords

Search

Navigation