Fan Jiali, Bai Jingjing, Liu Wei, Cai Jun
Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Cardiology, Beijing Jishuitan Hospital, Peking University Fourth Hospital, Beijing, China.
Front Neurol. 2023 Feb 1;14:1042637. doi: 10.3389/fneur.2023.1042637. eCollection 2023.
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.
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.
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 ( = 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, = 0.983).
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.
ClinicalTrials.gov. Unique identifier: NCT03015311.
STEP（老年高血压患者血压干预策略）试验表明，与标准治疗相比，强化收缩压（SBP）控制可降低心血管事件的发生率。本研究分析了强化降低SBP对认知功能的影响。
STEP是一项针对60 - 80岁高血压患者的多中心随机对照试验。参与者被随机分配（1:1）至SBP目标为110 - 130 mmHg（强化治疗）或130 - 150 mmHg（标准治疗）。每位个体在基线和随访期间均被要求完成一项认知功能测试（简易精神状态检查表；MMSE）。本研究的主要结局是MMSE评分的年度变化。得分低于特定教育程度截断点的受试者被归类为认知功能减退。
该分析纳入了6501名参与者（强化治疗组3270名参与者，标准治疗组3231名参与者）。中位随访时间为3.34年。MMSE评分有微小变化，强化治疗组和标准治疗组的年度变化分别为 - 0.001 [95%置信区间（CI） - 0.020, 0.018] 和0.030（95% CI 0.011, 0.049）（P = 0.052）。强化治疗组46/3270例患者（1.4%）发生认知功能减退，标准治疗组42/3231例患者（1.3%）发生认知功能减退（风险比0.005，95% CI 0.654, 1.543，P = 0.983）。
与标准治疗相比，强化SBP治疗并未导致认知功能测试评分出现显著变化。使用这种整体认知功能测试，强化降压的影响并不明显。
ClinicalTrials.gov。唯一标识符：NCT03015311。
