{"title":"Comparison of visit-to-visit blood pressure variability and time in target range in predicting risk for cognitive outcomes in the SPRINT trial.","authors":"Isabel J Sible, Daniel A Nation","doi":"10.1177/13872877241303378","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Blood pressure (BP) variability (BPV) and time in target range (TTR) are emerging vascular risk factors for dementia, independent of traditionally targeted mean BP.</p><p><strong>Objective: </strong>Determine whether BPV or TTR is most strongly associated with cognitive risk.</p><p><strong>Methods: </strong>In this post hoc analysis of the SPRINT trial, 8034 participants underwent repeated BP measurement and cognitive testing at baseline and follow-up. Visit-to-visit BPV was calculated as average real variability. TTR was the percent of time in desired treatment arm target range (standard: 120-140 mmHg systolic BP; intensive: 110-130 mmHg systolic BP). Adjudicated clinical outcomes were no cognitive impairment, mild cognitive impairment (MCI), and probable dementia. We investigated a direct comparison of BPV and TTR in predicting cognitive risk, stratified by BP treatment group.</p><p><strong>Results: </strong>Elevated BPV was associated with increased risk for MCI (adjusted HR: 1.21 [95% CI 1.10, 1.33], <i>p </i>< 0.001) and MCI/dementia (HR: 1.17 [95% CI 1.07, 1.27], <i>p </i>< 0.001) in the standard group, and dementia (HR: 1.17 [95% CI 1.01, 1.36], <i>p </i>= 0.039) in the intensive group. Higher TTR was related to lower dementia risk (HR: 0.72 [95% CI 0.60, 0.86], <i>p </i>< 0.001) in the intensive group only.</p><p><strong>Conclusions: </strong>Visit-to-visit BPV outperformed TTR in predicting risk for MCI and MCI/dementia. TTR was more strongly associated with dementia risk under intensive treatment. Findings were independent of mean BP in a cohort with rigorously controlled BP and suggest newer aspects of BP control may be harnessed to further reduce cognitive risk.</p><p><strong>Clinical trial information: </strong>ClinicalTrials.gov; NCT01206062.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"13872877241303378"},"PeriodicalIF":3.4000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Alzheimer's Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/13872877241303378","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Blood pressure (BP) variability (BPV) and time in target range (TTR) are emerging vascular risk factors for dementia, independent of traditionally targeted mean BP.
Objective: Determine whether BPV or TTR is most strongly associated with cognitive risk.
Methods: In this post hoc analysis of the SPRINT trial, 8034 participants underwent repeated BP measurement and cognitive testing at baseline and follow-up. Visit-to-visit BPV was calculated as average real variability. TTR was the percent of time in desired treatment arm target range (standard: 120-140 mmHg systolic BP; intensive: 110-130 mmHg systolic BP). Adjudicated clinical outcomes were no cognitive impairment, mild cognitive impairment (MCI), and probable dementia. We investigated a direct comparison of BPV and TTR in predicting cognitive risk, stratified by BP treatment group.
Results: Elevated BPV was associated with increased risk for MCI (adjusted HR: 1.21 [95% CI 1.10, 1.33], p < 0.001) and MCI/dementia (HR: 1.17 [95% CI 1.07, 1.27], p < 0.001) in the standard group, and dementia (HR: 1.17 [95% CI 1.01, 1.36], p = 0.039) in the intensive group. Higher TTR was related to lower dementia risk (HR: 0.72 [95% CI 0.60, 0.86], p < 0.001) in the intensive group only.
Conclusions: Visit-to-visit BPV outperformed TTR in predicting risk for MCI and MCI/dementia. TTR was more strongly associated with dementia risk under intensive treatment. Findings were independent of mean BP in a cohort with rigorously controlled BP and suggest newer aspects of BP control may be harnessed to further reduce cognitive risk.
背景：血压（BP）变异性（BPV）和目标范围内时间（TTR）是新出现的痴呆血管危险因素，独立于传统的目标平均血压。目的：确定BPV或TTR是否与认知风险最密切相关。方法：在SPRINT试验的事后分析中，8034名参与者在基线和随访期间进行了重复的血压测量和认知测试。访问-访问BPV计算为平均实际变异性。TTR是在预期治疗组目标范围内的时间百分比(标准：120-140 mmHg收缩压；强化：110-130 mmHg收缩压)。判定的临床结果为无认知障碍、轻度认知障碍（MCI）和可能的痴呆。我们研究了BPV和TTR在预测认知风险方面的直接比较，并按BP治疗组分层。结果：强化组BPV升高与MCI风险增加相关（调整后危险度：1.21 [95% CI 1.10, 1.33], p p p = 0.039）。较高的TTR与较低的痴呆风险相关（HR: 0.72 [95% CI 0.60, 0.86], p）。结论：在预测MCI和MCI/痴呆风险方面，访-访BPV优于TTR。在强化治疗下，TTR与痴呆风险的相关性更强。在严格控制血压的队列中，研究结果与平均血压无关，表明可以利用新的血压控制方法进一步降低认知风险。临床试验信息：ClinicalTrials.gov；NCT01206062。
期刊介绍：
The Journal of Alzheimer''s Disease (JAD) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer''s disease. The journal publishes research reports, reviews, short communications, hypotheses, ethics reviews, book reviews, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research that will expedite our fundamental understanding of Alzheimer''s disease.
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