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Lower BP Targets Preserve Cognition in Older Adults
Lower targets for systolic blood pressure (SBP) in older individuals appear to preserve cognitive function, with the effect significantly stronger in black patients, new research shows.
“This analysis of 10-year data from older adults receiving treatment for hypertension in the Health ABC study suggests that lower SBP levels are associated with greater cognitive protection. The lower targets may offer greater protection for older black adults with hypertension,” the investigators, led by Ihab Hajjar, MD, Emory School of Medicine, Atlanta, Georgia, write.
The study was published online August 21 in JAMA Neurology.
Effect by Race
Previous hypertension guidelines from the Seventh Joint National Committee (JNC-7) recommended treatment for older adults at a cutoff of 140 mm Hg. However, the eighth committee (JNC-8) raised the target in 2014 to 150 mm Hg for individuals aged 60 years and older because of concern that the lower cutoff may have adverse effects, including cognitive decline, falls, and mortality.
Meanwhile, clinical trials have shown benefits in favor of the lower target, with the Systolic Blood Pressure Intervention Trial (SPRINT) in 2015 showing a lower risk for cardiovascular disease without the increased risk for falls with the more aggressive 120–mm Hg target in individuals under, as well as over, age 75 years.
However, findings on cognitive outcomes from that study have not yet been reported.
To examine this issue, investigators evaluated data from 1657 cognitively intact older adults receiving treatment for hypertension who participated in the Health Aging and Body Composition (Health ABC) study and were studied from 1997 to 2007. Data were analyzed from October 2016 to January 2017.
Of this cohort, 908 patients were women and 784 were black. The mean age was 74 years, and all patients were cognitively intact at baseline.
Cognition was assessed by using the Modified Mini-Mental State Examination (3MSE) four times and the Digit Symbol Substitution Test (DSST) five times during the study. Results showed a differential decrease in 3MSE and DSST scores by SBP. The greatest decrease was in the group that had SBP of 150 mm Hg or higher.
The adjusted decrease was 3.7 points for 3MSE and 6.2 points for DSST. The lowest decrease was in the group with SBP of 120 mm Hg or lower, with an adjusted decrease of 3.0 for 3MSE and 5.0 for DSST (P < .001 for both), the investigators report.
Patients with SBP of 150 mm Hg or higher were more likely to be black (54%). The investigators found that compared with white patients, black patients showed significantly greater differences in cognition based on SBP.
Adjusted differences between the group with SBP of 150 mm Hg or higher and the group with SBP of 120 mm Hg or lower were –0.05 in white patients and –0.08 in black patients on the 3MSE assessment (P = .03) and –0.07 in white patients and –0.13 in black patients for DSST (P = .05).
The authors note that the findings are consistent with those of a recent studyof patients in the National Institutes of Health–National Institute on Aging Alzheimer Disease Centers, which also showed greater declines in cognition in people with SBP of 150 mm Hg or higher over a 3-year follow-up period compared with those with lower SBP targets.
“Because cognitive decline is a major risk factor for attrition (owing to death or loss to follow-up), as is hypertension, it is likely that the individuals at highest risk for poor cognitive outcomes may have not completed the 10-year follow- up, thus leading to a dilution of the true association between hypertension and cognitive decline,” Dr Gottesman writes.
She added that the finding that lower SBP was particularly protective for cognition in black patients is important given the known higher rates of dementia in this population and may have important implications for their care.
“Blood pressure reduction might actually reduce the rates of dementia and reduce the disparities by race with regard to dementia rates; the fact that blood pressure control may require more medications for black individuals than for white individuals needs to be considered when monitoring patients’ blood pressure levels,” Dr Gottesman writes.
The Health Aging and Body Composition study was funded by the National Institute on Aging, and the National Institute of Nursing Research. The research was also funded in part by the Intramural Research Program of the National Institutes of Health, National Institute on Aging. The authors have disclosed no relevant financial relationships. Dr Gottesman is an associate editor for Neurology.
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