Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions

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Abstract

The effect of intensive blood pressure lowering on brain health remains uncertain.

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Most cited references 16

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The overlap between vascular disease and Alzheimer’s disease – lessons from pathology

Johannes Attems, Kurt A Jellinger (2014)

Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer’s disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.

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Alternative Transformations to Handle Extreme Values of the Dependent Variable

John B. Burbidge, Lonnie Magee, A Robb (1988)

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The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT).

Peter Wright, Paul K. Whelton, Jackie K. Cheung … (2014)

High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial. To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants. The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ≥50 years (no upper limit) with an average baseline systolic blood pressure ≥130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ≥15%, or age ≥75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease. Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ≥75 years of age. Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned. The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ≥75 years. © The Author(s) 2014.

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Author and article information

Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date Created: August 13 2019

Publication date (Print): August 13 2019

Volume: 322

Issue: 6

Page: 524

Affiliations

[1 ]Department of Radiology, University of Pennsylvania, Philadelphia

[2 ]Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina

[3 ]Department of Neurology, University of Mississippi Medical Center, Jackson

[4 ]Department of Neurology, University of Utah School of Medicine, Salt Lake City

[5 ]Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City

[6 ]Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

[7 ]Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina

[8 ]Department of Psychology, University of Alabama at Birmingham

[9 ]Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee

[10 ]Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland

[11 ]Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland

[12 ]Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis

[13 ]Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Disorders, Bethesda, Maryland

[14 ]Division of Nephrology, Stanford University School of Medicine, Palo Alto, California

[15 ]Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland

[16 ]Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio

[17 ]Department of Epidemiology, University of Alabama at Birmingham

[18 ]National Institute of Neurological Disorders and Stroke, Bethesda, Maryland

[19 ]Department of Medicine, University of Alabama at Birmingham

[20 ]Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio

[21 ]Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

[22 ]Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

[23 ]Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina

[24 ]Now with Genentech, South San Francisco, California

[25 ]Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio

[26 ]Division of Geriatrics, University of Utah School of Medicine, Salt Lake City

[27 ]Division of Nephrology, Tufts Medical Center, Boston, Massachusetts

[28 ]Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana

[29 ]Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio

Article

DOI: 10.1001/jama.2019.10551

PMC ID: 6692679

PubMed ID: 31408137

SO-VID: 56a6ea62-9846-43d1-b021-d8a86bcd7cbf

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Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions

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Most cited references 16

The overlap between vascular disease and Alzheimer’s disease – lessons from pathology

Alternative Transformations to Handle Extreme Values of the Dependent Variable

The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT).

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Article

History

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Similar content 752

Cited by 150

Most referenced authors 938