white coat hypertension, blood pressure, blood pressure measurement, blood pressure and dementia, highly variable blood pressure, high blood pressure, aggressive blood pressure control

A new study suggests that aggressive blood pressure control may have modest benefits for cognitive function (The SPRINT MIND investigators, JAMA, Jan. 28, 2019). That is the conclusion from a follow-up on a clinical trial that originally showed getting systolic blood pressure to 120 could prevent some heart attacks and strokes.

How Well Did Aggressive Blood Pressure Control Work?

In 2010 researchers recruited 9,300 people over 50 to participate in the SPRINT trial. This stands for Systolic Blood Pressure Intervention Trial. The participants all had high blood pressure. However, none had diabetes or cognitive dysfunction when the study began.

The investigators randomly assigned these volunteers to get their blood pressure down to 120 (intensive blood pressure control) or under 140 (standard control). The group on standard treatment served as the control group for the trial.

Those who were assigned to intensive blood pressure control were prescribed as many drugs as were necessary to achieve the goal. Some subjects took as many as three or four different medications (SPRINT Research Group, New England Journal of Medicine, Nov. 26, 2015).

This secondary study was dubbed SPRINT MIND. The volunteers participated in cognitive tests both at baseline and after three to five years of treatment.

The Results of SPRINT MIND:

People in the intensive blood pressure control arm were slightly less likely to develop dementia during the five years of the study. Unfortunately, the difference was too small to be statistically significant. There were 149 cases in the aggressive blood pressure control arm. In comparison, 176 in the standard treatment group developed dementia. That works out to 7.2 per 1,000 person-years for the intervention. Conversely, the rate was 8.6 cases/1,000 person-years in the control group.

Mild cognitive impairment is a less severe problem, but it’s more common. This complication occurred in 14.6 cases per 1000 person years in the intensive treatment arm. People in the standard treatment arm had a rate of mild cognitive impairment of 18.3 per 1000 person years. Unlike the results on dementia, this difference was statistically significant. The relative risk reduction was 19 percent, but absolute risk dropped by a modest 0.4 percent.

The authors concluded that:

“Among adults with hypertension, intensive blood pressure control did not significantly reduce the risk of probable dementia.”

They speculated that the study may have been underpowered to detect the influence of aggressive blood pressure control on dementia. Nonetheless, that still suggests that any effect that might have been missed is probably not very large.

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  1. Nanci L.
    suburban Chicago
    Reply

    The blood pressure medication that I have been on for 6 years, Atenolol, causes insomnia, and supposedly, dementia (with long term use.) If there was a really good blood presure medication, without any side effects, I would gladly take it. So would most high BP sufferers. The drug industry would probably charge a high price for this “wonder” drug!

  2. Shalbhadra B.,MD
    Michigan
    Reply

    Seniors and other adults take too many supplements not needed, including too many psych drugs. Multiple MDs treat each symptom is treated with multiple meds. Too bad.

  3. cordelia
    sulphur
    Reply

    Who in their right mind would ever take 3 or 4 meds for any ailment? It seems like the side effects would cancel any benefit. Eat an additive-free meal, take some Ginkgo Smart and walk, walk, walk.

    I’m 81, take Olmesartan/hydro 40/25 and Ginkgo, plus many other a,b,c,d,e,supplements ,find what works for you.

    • Sally
      WA
      Reply

      And there are people who would think that you are outta your mind for taking so many supplements. To each their own.

  4. Donald
    Olympia, Wa
    Reply

    SENIOR ZOMBIELAND

    The drug companies get their wish again. The Seniors all have blood pressure below 115/75, because the Seniors take Blood Pressure medication every day, sit zoned out in their rocking chairs, and they keep taking the BP pills until they’re 100 years old.

    It’s a blessing for the drug companies. But, it’s hell for seniors, who want to do something besides being doped up every day.

    Give me BP 135/85 to 150/90 instead. I can still think, walk, workout, swim, play tennis, or play cards until I’m 85. The zombies can have the years after 85. I won’t miss being a shell of myself for the last 15 years.

    But the drug companies will miss the money.

    • Sally
      WA
      Reply

      Where are you getting the figure 115/75? I thought it was 120/80.

  5. Randy
    OR
    Reply

    I would like to emphasize a critical point in regard to The People’s Pharmacy’s reporting of this study’s findings. By definition, if the difference between the control group and treatment group is not statistically significant, it is not appropriate to conclude that “People in the intensive blood pressure control arm were slightly less likely to develop dementia during the five years of the study.” “No statistical difference” means that the difference between the control and treatment groups could be accounted for by random variation (anytime you look for dementia in two groups of people you will find variation between the groups). The critical question is whether the difference is great enough that we can be certain it’s the result of the treatment, not just random variation. In this study, the authors found no significant difference, so it is misleading to conclude that there was a difference between the groups, just not big enough to count statistically. If it doesn’t count statistically, then the study found no difference between the treatment and control, not even a slight one.

  6. Nancy
    Reply

    I agree that the title was misleading. This is the very thing you point out in your article on statins: publications use headlines that are the opposite of what a study shows.

  7. Dr Richard
    West Palm Beach
    Reply

    Tis article is incomplete at best and a teaser. What is aggressive blood pressure control? Is it a fast. 500mg Amaldopine Besylate and 200 mg of Xarelto daily (only hyperbole) ? Or Eating twelve stalks of celery raw and four red peppers cooked daily. Without this information how can one consider any conclusion offered. Generally, the people’s Pharmacy presents much clearer and better defined articles than this. I suggest rewriting this article because it slipped past the editor.

    • sally
      WA
      Reply

      Those who were assigned to intensive blood pressure control were prescribed as many drugs as were necessary to achieve the goal. Some subjects took as many as three or four different medications (SPRINT Research Group, New England Journal of Medicine, Nov. 26, 2015).

  8. Pat
    Portland,Oregon
    Reply

    In my opinion, the drugs used to bring BP down to 120 is much worse than being under 140 for the elderly. I am almost 81 years old and the BP lowering drugs often cause light headed and dizziness which causes falls and broken hips, etc. Eating a healthy diet and exercising and not worrying about getting BP numbers so, low are much better than more drugs. The elderly are many times overwhelmed with a pill for this and a pill for that. Who knows how those drugs interact with each other and the individuals own body chemistry. The ‘”EXPERTS”, are always changing their minds and disagreeing with each other any way.

  9. Isabella
    Reply

    I have Blood Preasure spiking to 206/102, pulse 99. Finally, after 6 months I was diagnosed with
    high levels of aldosterone that elevates blood pressure. I can’t tolerate any medication that may help other than water pill Hydrochlorothiazide 25 mg I have been self medicating with castor oil and garlic pill. It only reduced BP to 165/78. Still not good. I wish I had help.

    • Aya
      Maryland
      Reply

      There are veggies that could help: try juicing celery and drinking a cup every day, beets are excellent, pomegranate juice (sugar free and cold pressed). Daily aerobic exercise. It takes a complete lifestyle change — exercise, diet etc., in addition to the med you’re currently taking.

    • Jeanine
      CT
      Reply

      Dear Isabella,

      There are a few things you can try in your diet such as drinking sparkling Pellegrino water. Aldosterone changes after consumption of a sodium-bicarbonated mineral water in humans. A four-way randomized controlled trial.
      https://www.ncbi.nlm.nih.gov/pubmed/27356528
      The Hydrochlorothiazide 25 mg is causing your body to become dehydrated and that causes elevation in BP. Also, grapeseed extract is another supplement to consider. https://universityhealthnews.com/daily/heart-health/grape-seed-extract-benefits-blood-pressure-and-cholesterol/

      But most importantly, sugar causes most of the BP pressure problems. I have made these changes with my 84 year old father and his BP is consistent at 125/79. He was having the same problem as you are. No meds or water pill anymore. He takes magnesium at night with a banana for potassium and uses Ultima for added electrolytes in his water. There is papaya leaf tea or Tart Cherry juice. But the reduction in sugar is most important and the timing of eating meals was another. He plays softball every day and has had consistent BP readings.

  10. Maynard
    NC
    Reply

    The title was very misleading. Had I not taken time to read the article, I might have thought there was a strong correlation–and would have been wrong (despite the word “may”). Please use representative headings–not teaser ones. E.G. “may not save your brain.”

    • Terry Graedon
      Reply

      Good point, Maynard. We will keep that in mind for the future.

  11. Anne
    Wisconsin
    Reply

    I find myself always wondering about my mother. And, of course, I worry about developing the same problems. She was diagnosed with Alzheimer’s, but she had very high blood pressure as well. She seemed to have so many things going on that possibly contributed, along with ADHD. My dad also had ADHD, but low blood pressure, and he never showed any signs of Alzheimer’s or dementia.

  12. luke
    Reply

    Aggressive blood pressure control can also lead to orthostatic hypotension and falls. This research is, at best, shabby.

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