Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial

Jiali Fan; Jingjing Bai; Wei Liu; Jun Cai

doi:10.3389/fneur.2023.1042637

Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial

Front Neurol. 2023 Feb 1:14:1042637. doi: 10.3389/fneur.2023.1042637. eCollection 2023.

Authors

Jiali Fan¹, Jingjing Bai¹, Wei Liu², Jun Cai¹

Affiliations

¹ Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
² Department of Cardiology, Beijing Jishuitan Hospital, Peking University Fourth Hospital, Beijing, China.

Abstract

Background: The STEP (Strategy of Blood Pressure Intervention in the older Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control resulted in a lower incidence of cardiovascular events than standard treatment. This study analyzed the effects of intensive SBP lowering on cognitive function.

Methods: STEP was a multicenter, randomized controlled trial of hypertensive patients aged 60-80 years. Participants were randomly assigned (1:1) to SBP goals of 110-130 mmHg (intensive treatment) or 130-150 mmHg (standard treatment). Each individual was asked to complete a cognitive function test (Mini-Mental State Examination; MMSE) at baseline and during follow-up. The primary outcome for this study was the annual change in MMSE score. Subjects with a score less than education-specific cutoff point were categorized as cognitive decline.

Results: The analysis enrolled 6,501 participants (3,270 participants in the intensive-treatment and 3,231 participants in the standard-treatment groups). Median follow-up was 3.34 years. There was a minor change in MMSE score, with an annual change of -0.001 [95% confidence interval [CI] -0.020, 0.018] and 0.030 (95% CI 0.011, 0.049) in the intensive- and standard-treatment groups, respectively (p = 0.052). Cognitive decline occurred in 46/3,270 patients (1.4%) in the intensive-treatment group and 42/3,231 (1.3%) in the standard-treatment group (hazard ratio 0.005, 95% CI 0.654, 1.543, p = 0.983).

Conclusions: Compared with standard treatment, intensive SBP treatment did not result in a significant change in cognitive function test score. The impact of intensive blood pressure lowering was not evident using this global cognitive function test.

Trial registration: ClinicalTrials.gov. Unique identifier: NCT03015311.

Keywords: Mini-Mental State Examination; cardiovascular events; cognitive function; intensive BP treatment; standard BP treatment.

Associated data

ClinicalTrials.gov/NCT03015311

Grants and funding

This work was supported by CAMS Innovation Fund for Medical Sciences (CIFMS, 2021-I2M-1-007), National Natural Science Foundation of China (Project ID, 81825002), Beijing Outstanding Young Scientist Program (Project ID, BJJWZYJH01201910023029), and Beijing Municipal Science and Technology Commission (Project ID, Z191100006619106 and Z201100005620006).