Nicholas M Pajewski1, Dan R Berlowitz2,3, Adam P Bress4, Kathryn E Callahan5, Alfred K Cheung6, Larry J Fine7, Sarah A Gaussoin1, Karen C Johnson8, Jordan King4,9, Dalane W Kitzman10, John B Kostis11, Alan J Lerner12, Cora E Lewis13, Suzanne Oparil14, Mahboob Rahman15, David M Reboussin1, Michael V Rocco16, Joni K Snyder17, Carolyn Still18, Mark A Supiano19,20, Virginia G Wadley14, Paul K Whelton21, Jackson T Wright22, Jeff D Williamson5. 1. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina. 2. Bedford Veterans Affairs Hospital, Bedford, Massachusetts. 3. Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts. 4. Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah. 5. Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 6. Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, Utah. 7. Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland. 8. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. 9. Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado. 10. Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 11. Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. 12. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio. 13. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. 14. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 15. Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio. 16. Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 17. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. 18. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. 19. Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah. 20. Geriatric Research, Education, and Clinical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah. 21. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. 22. Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
Abstract
OBJECTIVES: To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN: Secondary analysis. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older. INTERVENTION: Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS: We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS: Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION: In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.
OBJECTIVES: To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN: Secondary analysis. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older. INTERVENTION: Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS: We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS: Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION: In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.
Authors: Alfredo J Selim; William Rogers; John A Fleishman; Shirley X Qian; Benjamin G Fincke; James A Rothendler; Lewis E Kazis Journal: Qual Life Res Date: 2008-12-03 Impact factor: 4.147
Authors: Walter T Ambrosius; Kaycee M Sink; Capri G Foy; Dan R Berlowitz; Alfred K Cheung; William C Cushman; Lawrence J Fine; David C Goff; Karen C Johnson; Anthony A Killeen; Cora E Lewis; Suzanne Oparil; David M Reboussin; Michael V Rocco; Joni K Snyder; Jeff D Williamson; Jackson T Wright; Paul K Whelton Journal: Clin Trials Date: 2014-06-05 Impact factor: 2.486
Authors: Jeff D Williamson; Mark A Supiano; William B Applegate; Dan R Berlowitz; Ruth C Campbell; Glenn M Chertow; Larry J Fine; William E Haley; Amret T Hawfield; Joachim H Ix; Dalane W Kitzman; John B Kostis; Marie A Krousel-Wood; Lenore J Launer; Suzanne Oparil; Carlos J Rodriguez; Christianne L Roumie; Ronald I Shorr; Kaycee M Sink; Virginia G Wadley; Paul K Whelton; Jeffrey Whittle; Nancy F Woolard; Jackson T Wright; Nicholas M Pajewski Journal: JAMA Date: 2016-06-28 Impact factor: 56.272
Authors: Michael V Rocco; Kaycee M Sink; Laura C Lovato; Dawn F Wolfgram; Thomas B Wiegmann; Barry M Wall; Kausik Umanath; Frederic Rahbari-Oskoui; Anna C Porter; Roberto Pisoni; Cora E Lewis; Julia B Lewis; James P Lash; Lois A Katz; Amret T Hawfield; William E Haley; Barry I Freedman; Jamie P Dwyer; Paul E Drawz; Mirela Dobre; Alfred K Cheung; Ruth C Campbell; Udayan Bhatt; Srinivasan Beddhu; Paul L Kimmel; David M Reboussin; Glenn M Chertow Journal: Am J Kidney Dis Date: 2017-11-20 Impact factor: 8.860
Authors: Karen C Johnson; Paul K Whelton; William C Cushman; Jeffrey A Cutler; Gregory W Evans; Joni K Snyder; Walter T Ambrosius; Srinivasan Beddhu; Alfred K Cheung; Lawrence J Fine; Cora E Lewis; Mahboob Rahman; David M Reboussin; Michael V Rocco; Suzanne Oparil; Jackson T Wright Journal: Hypertension Date: 2018-03-12 Impact factor: 10.190
Authors: Taylor J Krivanek; Seth A Gale; Brittany M McFeeley; Casey M Nicastri; Kirk R Daffner Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472
Authors: Dae Hyun Kim; Curtis Tatsuoka; Zhengyi Chen; Jackson T Wright; Michelle C Odden; Srinivasan Beddhu; Brandon K Bellows; Adam Bress; Thaddeus Carson; William C Cushman; Karen C Johnson; Donald E Morisky; Henry Punzi; Leonardo Tamariz; Song Yang; Lee-Jen Wei Journal: J Gen Intern Med Date: 2022-08-09 Impact factor: 6.473