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Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial
SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung AK, Cleveland ML et al.. JAMA, 2019-02-01
Topic: Risk, prevention and care in population studies
Importance There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia. Objective To evaluate the effect of intensive blood pressure control on risk of dementia. Design, setting, and participants Randomized clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. The final date for follow-up of cognitive outcomes was July 22, 2018. Interventions Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683). Main outcomes and measures The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia. Results Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67-1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97). Conclusions and relevance Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point. Trial registration ClinicalTrials.gov Identifier: NCT01206062.
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APA 7th
SPRINT MIND Investigators for the SPRINT Research Group, Williamson, J. D., Pajewski, N. M., Auchus, A. P., Bryan, R. N., Chelune, G., et al. (2019). Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2018.21442
Vancouver
SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019. doi:10.1001/jama.2018.21442. PMID: 30688979.
BibTeX
@article{study2019-30688979,
author = {{SPRINT MIND Investigators for the SPRINT Research Group} and Williamson, J. D. and Pajewski, N. M. and Auchus, A. P. and Bryan, R. N. and Chelune, G. and Cheung, A. K. and Cleveland, M. L. and others},
title = {{Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial}},
journal = {JAMA},
year = {2019},
doi = {10.1001/jama.2018.21442},
pmid = {30688979},
url = {https://doi.org/10.1001/jama.2018.21442}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- Results Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment.
- Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97).
- Conclusions and relevance Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia.
Why it matters
In 9,361 adults aged 50+ with hypertension (but no diabetes or prior stroke), aiming for a systolic blood pressure below 120 mm Hg instead of below 140 did not significantly reduce probable dementia, the trial's main cognitive outcome (7.2 vs 8.6 cases per 1000 person-years; HR 0.83, 95% CI 0.67–1.04). The intensive target did reduce mild cognitive impairment (HR 0.81, 95% CI 0.69–0.95), a secondary outcome. The authors note the trial was stopped early with fewer dementia cases than expected and "may have been underpowered" for dementia, so the dementia result is unresolved rather than negative.
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Study details
- Participants4,678
- Effect size35.6%; 91.5%
- Evidence strengthHigh
How this study scored 77/100
Published in a top-tier journal. Scored zero for study design because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 4,678 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 7 / 7 | Cited 1,229 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 136.6 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 6 / 6 | Cited 113.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 74 other studies in this library |
| Still being cited | 4 / 4 | Cited 430 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Clinton B. Wright: h-index 67 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | National Institutes of Health: institution h-index 2,723 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 20 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 30688979) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 77 / 100 | — |
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