TY - JOUR
T1 - Clinical trials in vascular cognitive impairment following SPRINT-MIND
T2 - An international perspective
AU - Elahi, Fanny M.
AU - Alladi, Suvarna
AU - Black, Sandra E.
AU - Claassen, Jurgen A.H.R.
AU - DeCarli, Charles
AU - Hughes, Timothy M.
AU - Moonen, Justine
AU - Pajewski, Nicholas M.
AU - Price, Brittani R.
AU - Satizabal, Claudia
AU - Shaaban, C. Elizabeth
AU - Silva, Nárlon C.B.S.
AU - Snyder, Heather M.
AU - Sveikata, Lukas
AU - Williamson, Jeff D.
AU - Wolters, Frank J.
AU - Hainsworth, Atticus H.
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/6/20
Y1 - 2023/6/20
N2 - A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.
AB - A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.
KW - aging
KW - blood pressure
KW - clinical trials
KW - cognitive impairment
KW - dementia
KW - hypertension
KW - prevention
KW - vascular disease
UR - http://www.scopus.com/inward/record.url?scp=85162213592&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85162213592&partnerID=8YFLogxK
U2 - 10.1016/j.xcrm.2023.101089
DO - 10.1016/j.xcrm.2023.101089
M3 - Review article
C2 - 37343515
AN - SCOPUS:85162213592
SN - 2666-3791
VL - 4
JO - Cell Reports Medicine
JF - Cell Reports Medicine
IS - 6
M1 - 101089
ER -