American Heart Association Scientific Sessions 2023, latest scientific summary on LBS.04
Research Highlights:
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An intensive four-year blood pressure intervention significantly reduced the risk of developing dementia among adults with high blood pressure compared to people who received usual care, in a study published today as Breaking Science in Scientific Sessions 2023. the American Heart Association . The meeting, to be held November 11-13 in Philadelphia, is a major global exchange of the latest scientific advances, research and evidence-based clinical practice updates in cardiovascular science.
"In the absence of curative treatments, primary prevention of dementia by reducing risk factors has become a public health priority," said Jiang He, M.D., Ph.D., FAHA, professor of epidemiology and medicine. and director of Tulane. University of New Orleans Translational Sciences Institute. "Previous observational studies have found that people with untreated hypertension have a 42% increased risk of dementia compared to healthy adults, while people with treated hypertension have no significant increased risk of dementia compared to healthy adults. ".
Researchers evaluated the effectiveness of lowering blood pressure on the risk of dementia among people with high blood pressure. The study was conducted in 326 villages in rural China and included approximately 34,000 adults , ages 40 and older, with untreated blood pressure of 140/90 mm Hg or higher, or 130/80 mm Hg or higher for people at high risk. of cardiovascular disease. or those currently taking blood pressure medications.
Half of the villages were randomly assigned to a physician-led intensive blood pressure intervention strategy, and the other half of the villages were randomly assigned to usual care. Patients in usual care villages received hypertension treatment from local village doctors or primary care doctors in municipal hospitals as part of the routine health service covered by the New China Rural Cooperative Medical Plan ( a health insurance plan that covers approximately 99% of rural residents for basic care). health care services in China).
In the intervention group, antihypertensive medications were initiated and adjusted by trained rural physicians based on a simple treatment protocol to achieve the goal of reducing systolic blood pressure to less than 130 mm Hg and diastolic blood pressure to less than 80 mm Hg. with primary care supervision. doctors. The step-by-step protocol for hypertension management included a treatment algorithm, medication selection, review of medication contraindications, and finally, strategies for dosage adjustment. They also provided free and discounted blood pressure medications to patients and conducted health counseling on lifestyle modifications, home blood pressure measurement, and medication adherence.
At the end of the four-year study period, cognitive function assessments or screenings were performed by trained and certified neurologists who were blinded to randomization assignments. The final diagnosis of all-cause dementia or cognitive impairment, not dementia, was made by an adjudication panel of experts, who also did not know which intervention the study participants were assigned to. Cognitive impairment, not dementia is a broad classification for reduced cognitive functioning that does not meet the criteria for dementia but exceeds normal age-related cognitive decline.
The analysis found that people in the intervention group showed a significant improvement in blood pressure control and a reduction in dementia and cognitive decline, without dementia compared to those who received usual care. Additional findings:
The average blood pressure in the intervention group at 48 months was 128/73 mm Hg, compared with 148/81 mm Hg in the usual care group.
On average, systolic blood pressure decreased 22 mm Hg and diastolic blood pressure decreased 9 mm Hg among people in the intervention group compared to usual care.
People in the intervention group had a 15% lower risk of dementia and a 16% lower risk of memory impairment compared to the group receiving usual care.
Serious adverse events, such as hospitalizations and death from all causes, were also less common in the intervention group.
"This is the first large randomized trial to show that lowering blood pressure is effective in reducing the risk of dementia in people with high blood pressure," he said. "These findings emphasize the importance of widespread adoption of more intensive blood pressure control to reduce the global burden of dementia."
Study details and background:
The trial began in May 2018 and ended in March 2023.
The average age of study participants at enrollment was 63 years. 61% identified as women and 39% as men; The researchers observed similar reductions in blood pressure and dementia risk in women and men.
Limitations of the study included that the researchers did not assess participants’ cognitive function during baseline examinations when they enrolled in the trial.
Future studies are needed to examine whether lowering blood pressure will reduce the risk of dementia among adults at high risk for dementia without high blood pressure.
The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults classifies stage 1 hypertension with upper and lower numbers greater than or equal to 130/80 mm Hg and stage 2 hypertension as with upper and lower numbers greater than or equal to 130/80 mm Hg. lower numbers greater than or equal to 140/90 mm Hg.
According to the American Heart Association’s 2023 Statistical Update, nearly half of adults in the U.S. have high blood pressure. The estimated rate of dementia (alone, not including Alzheimer’s) in American adults aged 65 and older was 10.5% in 2012, with a rate of 7.3% in men and 12.9% in women, according to Aging, Demographics and Memory Study, a companion study to the Long-Term Health and Retirement Study.
