Estimated pulse wave velocity and cognitive outcomes: A post hoc analysis of SPRINT-MIND

Peng Hao; Siting Feng; Min Suo; Shen Wang; Keyang Zheng; Xiaofan Wu

doi:10.1093/ajh/hpae032

Estimated pulse wave velocity and cognitive outcomes: A post hoc analysis of SPRINT-MIND

Am J Hypertens. 2024 Mar 15:hpae032. doi: 10.1093/ajh/hpae032. Online ahead of print.

Authors

Peng Hao¹, Siting Feng², Min Suo¹, Shen Wang¹, Keyang Zheng³, Xiaofan Wu¹

Affiliations

¹ Integrated Ward of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
² Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
³ Center of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

PMID: 38488616
DOI: 10.1093/ajh/hpae032

Abstract

Background: Arterial stiffness has been confirmed to be associated with cognitive impairment. Carotid-femoral pulse wave velocity (cfPWV) is widely regarded as the gold standard for assessing arterial stiffness, yet it is not readily accessible. In response, the use of estimated pulse wave velocity (ePWV) has been proposed as a more accessible and cost-effective alternative. ePWV not only offers ease of calculation but also covers a broader spectrum of vascular aging processes, some of which may be distinct from those detected by cfPWV. The aim of our study was to investigate the association between ePWV and cognitive outcomes in SPRINT-MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension).

Methods: This study was a post-hoc analysis of the SPRINT-MIND. The primary endpoint was a composite outcome including probable dementia and mild cognitive impairment (MCI). The calculation of ePWV was based on age and mean blood pressure. The association between ePWV and cognitive outcomes was assessed using Cox regression analysis. The response of ePWV to antihypertensive treatment at 12 months was used to define treatment efficacy.

Results: 8563 patients were enrolled. The ePWV was found to be independently associated with risk of probable dementia (Tertile 3 vs. Tertile 1: HR, 95% CI: 1.70, 1.08-2.68, P = 0.023, P for trend = 0.013), MCI (Tertile 3 vs. Tertile 1: HR, 95% CI: 2.35, 1.71-3.23, P < 0.001, P for trend < 0.001), and the composite outcome of probable dementia or MCI (Tertile 3 vs. Tertile 1: HR, 95% CI: 2.17, 1.65-2.86, P < 0.001, P for trend < 0.001). The combined effect of treatment allocation and the response of ePWV to treatment exhibited that intensive/ePWV responders had the lowest risk of the primary outcome (Log-rank P = 0.002).

Conclusion: EPWV demonstrated independent predictive value for cognitive outcomes in SPRINT-MIND.

Keywords: Estimated pulse wave velocity; arterial stiffness; intensive blood pressure treatment; mild cognitive impairment; probable dementia.