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The main new study finds that lowering blood pressure can prevent cognitive decline, but questions remain



Photo: Adam Berry (Getty Images)

About five million Americans live with dementia, most often with Alzheimer's disease. And it is almost certain that dementia will become more and more common as the general population advances. But a new study published this week suggests some encouraging news if mixed. It is possible to prevent cognitive decline by aggressively treating high blood pressure, the study found. Unfortunately, it is unclear whether lowering of blood pressure can do the same for dementia.

In 201

0, a project known as the Systolic Intervention Trial, or SPRINT, was launched. It recruits nearly 10,000 volunteers over 50 years of age with high blood pressure and at least one other risk factor for cardiovascular diseases such as smoking. The aim of the study is to compare whether attempting to reduce people's systolic blood pressure (the highest figure in blood pressure) below 120 would be better for people's overall health than to try to reduce it to 140 At which point the final threshold was

Cardiovascular disease is the main health outcome surveyed by the SPRINT study, which ended in early 2015, after it became clear that the quest for 120 was better to prevent things such as heart attacks and stroke than a standard Nittel care. However, a subgroup of about 8,500 volunteers has also been studied for their potential risk of dementia and mild cognitive impairment (MCI), an earlier stage of memory loss and brain drain that often progress to dementia.

The results of this study published Monday at JAMA comes from this side project called the SPRINT MIND study. Aggressively treated, relatively healthy people were found to be significantly less likely to develop MCI than those who were given standard care. The rate of new MCI cases is 19% lower in this group

High blood pressure is a risk factor for all types of conditions, including cognitive decline. But while scientists have largely assumed that maintaining blood pressure should help prevent dementia, we currently have no real evidence from human studies that any potential intervention can reduce the rate of dementia. So the results of SPRINT MIND are definitely good news in this sense.

But there is also a great warning for the study. After all, although there was a small reduction in new cases of complete dementia in the aggressive treatment group, this was not a statistically significant difference from the standard care group. In other words, the study did not actually achieve its original result.

It can usually be easy to reject the results of the SPRINT MIND study as an exaggerated oversupply. But there is one key point to be taken into consideration. Although not every person with MCI continues to develop dementia, everyone with dementia will first experience MCI. Since the study is over early, researchers may simply not have the time needed to establish a true reduction in dementia.

"The fact that there is still a MCI result when the study is interrupted makes these results encouraging," said Lauri Ryan, Head of Dementia Dementia at the National Institute of Aging (NIH). financing the initial SPRINT survey). So, while the study is not a home for the prevention of dementia, it's a promising advantage. In light of the findings, the Alzheimer's Association announced on Monday that it would help fund SPRINT MIND 2.0, a continuation of the initial study, which should provide two more years of follow-up data.

"The Alzheimer's Association believes that these data are convincing and committed to obtaining clarity and certainty regarding the outcome of dementia, following the participants for a longer period of time," said Maria Carilo, Chief Scientific Director of the Association of Alzheimer's.

We hope that time will really show if lowering of blood pressure can prevent dementia.

[JAMA via NIH, Alzheimer’s Association]


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