Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 68, Issue 3, Pages 496-504Publisher
WILEY
DOI: 10.1111/jgs.16272
Keywords
cardiovascular disease; hypertension; older adults; cognitive function
Categories
Funding
- National Institutes of Health (NIH) (National Heart, Lung, and Blood Institute [NHLBI]) [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN 268200900049C, A-HL-13-002-001]
- National Institutes of Health (NIH) (National Institute of Diabetes and Digestive and Kidney Diseases) [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN 268200900049C, A-HL-13-002-001]
- National Institutes of Health (NIH) (National Institute on Aging) [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN 268200900049C, A-HL-13-002-001]
- National Institutes of Health (NIH) (National Institute of Neurological Disorders and Stroke) [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN 268200900049C, A-HL-13-002-001]
- National Center for Advancing Translational Sciences [UL1TR000439, UL1RR025755, UL1RR024134, UL1TR000003, UL1RR025771, UL1TR000093, UL1RR025752, UL1TR000073, UL1TR001064, UL1TR000050, UL1TR000005, U54TR000017-06, UL1TR000105-05, UL1 TR000445, UL1TR000075, UL1 TR000002, UL1 TR000064, UL1TR000433]
- National Institute of General Medical Sciences, Centers of Biomedical Research Excellence award [NIGMS P30GM103337]
- Wake Forest Claude Pepper Center [P30AG021332]
- Alzheimer's Association
- [R01AG055606]
- [K01HL133468]
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OBJECTIVES To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN Secondary analysis. SETTING Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS Adults 80 years or older. INTERVENTION Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. Trial Registration identifier: NCT01206062.
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