Cardiometabolic Renal Health Profile, Intensive Blood Pressure-Lowering Treatment and Cognitive Dysfunction: A Post Hoc Analysis of the SPRINT Trial.
Siyu Wang, Kan Wang, Zhiping Tan et al.
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In 30 seconds
This post hoc analysis of the randomised SPRINT trial examined whether baseline cardiometabolic renal health profiles modified cognitive outcomes with intensive blood pressure lowering. Among 8162 participants with complete profile data (mean age 67.8 years; 35.2% women), exploratory analyses found lower risk of mild cognitive impairment (MCI) with intensive treatment in the favourable-profile tertile (adjusted HR 0.64, 95% CI 0.48-0.86). The largest absolute risk difference was also in this group (adjusted ARD, -3.05%; 95% CI, -4.85% to -1.24%), with interaction on the absolute-risk scale (p for interaction = 0.039).
Key findings
- In participants with favourable profiles, intensive blood pressure lowering was associated with lower MCI risk (adjusted HR 0.64, 95% CI 0.48-0.86).
- The favourable-profile group had the largest MCI absolute risk difference (adjusted ARD, -3.05%; 95% CI, -4.85% to -1.24%).
- Interaction across profile tertiles was significant for MCI on the absolute-risk scale (p for interaction = 0.039); no interaction was observed for other cognitive outcomes or adverse events.
Why it matters
The analysis suggests that baseline cardiometabolic and renal health may help identify groups in whom intensive blood pressure lowering is associated with greater absolute reduction in MCI. This may inform hypotheses about variation in cognitive outcomes, but the finding is exploratory and does not establish that profile-based treatment selection improves cognition.
What to keep in mind
This was a post hoc, exploratory analysis, and the authors state that the findings require validation in future studies.