A high BP must be brought down, right? Right. Common sense would dictate that and there can be no quarrel on that. But this is the day and age of evidence-based-medicine and doctors and patients alike would like to see documented proof of the safety and efficacy of the therapy they are resorting to. It is in that context and spirit that Dr Richard Isaacson, director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian Hospital talks about the SPRINT-MIND study which provides strong evidence in favour of reducing blood pressure in the elderly to reduce the risk of cognitive impairment.
The SPRINT-MIND trial was a study that looked at patients who had a variety of levels of blood pressure control. The usual group tried to get a target level of systolic blood pressure at 140; however, the more aggressive or tighter-control group tried to get that systolic blood pressure down to the 120s. When you look at lowering blood pressure just by those 20 mm Hg, unbelievably, in just 3 years of treatment, with just a few years of follow-up, tight control of blood pressure reduced the incidence of mild cognitive impairment by 19%. Considering all-cause dementia, there was a reduction of 17%.
This randomized study used a variety of blood pressure medicines. The good news here is that they used generic medications and the choice of medication really didn't seem to matter. As long as the person was able to get tighter control of blood pressure, there was a decreased incidence of cognitive impairment in this large randomized study.
The writing on the wall is clear. In a patient with cognitive impairment and raised BP, it is imperative to bring down the blood pressure as it is going to help the overall quality of life of the patient with improved cognitive function (Medscape 29 October 2018)