Effect of intensive blood pressure control on cognitive outcomes and brain structures in adults with type 2 diabetes: prespecified analysis of secondary outcomes of BPROAD randomised controlled trial.
Weiqing Wang, Yu Xu, Fengmei Xu et al.
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In 30 seconds
This prespecified secondary-outcome analysis of the multicentre, open-label, outcome assessor-masked BPROAD randomised trial examined intensive versus standard systolic blood pressure treatment in adults aged 50 years or older with type 2 diabetes, raised blood pressure and increased cardiovascular risk. Among 12,434 participants without probable dementia at baseline, intensive treatment targeting SBP <120 mm Hg did not significantly reduce dementia or mild cognitive impairment over a median 3.8 years (hazard ratio 0.96, 95% CI 0.86 to 1.06; P=0.38). In the MRI substudy, it was associated with less increase in white matter lesion volume.
Key findings
- Dementia or mild cognitive impairment occurred at 3.69 versus 3.89 events per 100 person years with intensive and standard treatment, respectively.
- The primary cognitive outcome did not differ significantly between groups (hazard ratio 0.96, 95% CI 0.86 to 1.06; P=0.38).
- Intensive treatment was associated with a smaller increase in white matter lesion volume (between-group difference -0.09 inverse hyperbolic sine (asinh) transformed cm 3, 95% CI -0.15 to -0.02; P=0.01).
Why it matters
In this population, more intensive blood pressure lowering did not demonstrate a reduction in the combined incidence of dementia or mild cognitive impairment over the observed follow-up. The MRI finding suggests a difference in white matter lesion progression, but this structural outcome should be distinguished from demonstrated cognitive benefit when interpreting the results.
What to keep in mind
The cognitive follow-up was a median of 3.8 years, and MRI outcomes were assessed in a subset of participants; the trial was open label, although outcome assessors were masked.