ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR46

Influence of Baseline Diastolic Blood Pressure on the Effect of Lowering Systolic Blood Pressure on Mild Cognitive Impairment and Probable Dementia

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Gupta, Aditi, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
  • Supiano, Mark A., University of Utah Health, Salt Lake City, Utah, United States
  • Burns, Jeffrey M., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
  • Williamson, Jeff D., Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
  • Pajewski, Nicholas M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Lowering of systolic blood pressure (SBP) with already low diastolic blood pressure (DBP), can potentially decrease cerebral perfusion and worsen cognition. We examined the influence of baseline DBP on the effect of lowering SBP on incident mild cognitive impairment (MCI) and probable dementia (PD).

Methods

In this post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) study (N = 8562), we examined the effects of intensive (<120 mmHg) vs standard (<140 mmHg) SBP control on a composite, adjudicated outcome of MCI/PD across the range of baseline DBP in a spline Cox regression model. We also tested for interactions of baseline DBP on the effect of SBP goal on MCI/PD.

Results

Mean age was 68±9 years, 35% were women and 66% White. There were 640 MCI/PD events over 39,022 participant-years. Compared to standard SBP, intensive SBP control further lowered the DBP in those in the lowest baseline DBP tertile (Figure 1A) but also lowered the risk of MCI/PD (Table 1). While lower baseline DBP was associated with higher risk of MCI/PD (Table 1), there was no evidence that intensive SBP lowering increased the risk of MCI/PD in those with low baseline DBP (Figure 1B) with with baseline DBP x SBP goal interaction p = 0.37.

Conclusion

Intensive SBP lowering that further lowered DBP did not increase the risk of MCI/PD in those with low baseline DBP. The association of low baseline DBP with greater risk of MCI/PD is unlikely to be causal.

Table 1: Cox proportional hazard models for hazard ratios for MCI/PD for each 5 mmHg decrease in DBP and intervention.
 SBP intervention aloneDBP alone Joint model
SBP intervention0.80 (0.69, 0.94) 0.81 (0.69, 0.95)
Each 5 mmHg decrease in DBP 1.17 (1.13, 1.20)1.17 (1.13, 1.20)

There was no interaction between baseline DBP and MCI/PD with the SBP intervention p=0.36

Funding

  • Other NIH Support