Clinical trials in vascular cognitive impairment following SPRINT-MIND: An international perspective | Semantic Scholar (2024)

This review will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance understanding of one of the leading health challenges of the authors' time.

The most recent scientific evidence on a few possible biomarkers previously identified for monitoring heart failure and associated cognitive impairment emerged only for interleukin-6, confirming the hypotheses of the increasingly studied heart-brain correlation.

Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.

The epidemiology, neuropathology, clinical management, genetics, preclinical models, and pathogenesis of hypertensive small vessel disease are reviewed, including initiating factors, molecular pathogenesis, relationships between arterial pathology and tissue damage, possible reversibility, pharmacological targets, and molecular biomarkers.

Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of more than 140mm Hg did not result in a significant reduction in the risk of probable dementia.

Intensive treatment was associated with a small but statistically significant greater decrease in hippocampal volume compared with standard treatment, consistent with the observation that intensive treatment is associated with greater decreases in total brain volume, and intensive treatment was not associated with changes in any of the other MRI biomarkers of AD compared with standards.

Intensive vs standard antihypertensive treatment was associated with increased, rather than decreased, cerebral perfusion, most notably in participants with a history of cardiovascular disease.

The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia.

The first large randomized controlled trials of multidomain lifestyle interventions to prevent cognitive impairment have been completed, and the results suggest that targeting interventions to individuals at risk of dementia is an effective strategy.

The ACCORD interventions did not result in long-term beneficial or adverse effects on cognitive or brain MRI outcomes at approximately 80months follow-up, and significant differences in therapeutic targets for each of the three interventions (glycaemic, BP and lipid) were not sustained.

Among hypertensive adults, targeting an SBP of less than 120 mm HG, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.

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