Sible Isabel J, Nation Daniel A
Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
J Alzheimers Dis. 2025 Jan;103(2):396-405. doi: 10.1177/13872877241303378. Epub 2024 Dec 16.
Blood pressure (BP) variability (BPV) and time in target range (TTR) are emerging vascular risk factors for dementia, independent of traditionally targeted mean BP.
Determine whether BPV or TTR is most strongly associated with cognitive risk.
In this post hoc analysis of the SPRINT trial, 8034 participants underwent repeated BP measurement and cognitive testing at baseline and follow-up. Visit-to-visit BPV was calculated as average real variability. TTR was the percent of time in desired treatment arm target range (standard: 120-140 mmHg systolic BP; intensive: 110-130 mmHg systolic BP). Adjudicated clinical outcomes were no cognitive impairment, mild cognitive impairment (MCI), and probable dementia. We investigated a direct comparison of BPV and TTR in predicting cognitive risk, stratified by BP treatment group.
Elevated BPV was associated with increased risk for MCI (adjusted HR: 1.21 [95% CI 1.10, 1.33], < 0.001) and MCI/dementia (HR: 1.17 [95% CI 1.07, 1.27], < 0.001) in the standard group, and dementia (HR: 1.17 [95% CI 1.01, 1.36], = 0.039) in the intensive group. Higher TTR was related to lower dementia risk (HR: 0.72 [95% CI 0.60, 0.86], < 0.001) in the intensive group only.
Visit-to-visit BPV outperformed TTR in predicting risk for MCI and MCI/dementia. TTR was more strongly associated with dementia risk under intensive treatment. Findings were independent of mean BP in a cohort with rigorously controlled BP and suggest newer aspects of BP control may be harnessed to further reduce cognitive risk.
ClinicalTrials.gov; NCT01206062.
血压变异性（BPV）和目标范围内时间（TTR）是新出现的痴呆症血管危险因素，独立于传统的目标平均血压。
确定BPV或TTR与认知风险的关联最为密切。
在SPRINT试验的这项事后分析中，8034名参与者在基线和随访时接受了重复血压测量和认知测试。就诊间血压变异性计算为平均实际变异性。TTR是处于期望治疗组目标范围内的时间百分比（标准：收缩压120 - 140 mmHg；强化：收缩压110 - 130 mmHg）。判定的临床结局为无认知障碍、轻度认知障碍（MCI）和可能的痴呆症。我们按血压治疗组分层，对BPV和TTR在预测认知风险方面进行了直接比较。
在标准组中，血压变异性升高与MCI风险增加（调整后HR：1.21 [95% CI 1.10, 1.33]，< 0.001）以及MCI/痴呆症风险增加（HR：1.17 [95% CI 1.07, 1.27]，< 0.001）相关，在强化组中与痴呆症风险增加（HR：1.17 [95% CI 1.01, 1.36]，= 0.039）相关。仅在强化组中，较高的TTR与较低的痴呆症风险相关（HR：0.72 [95% CI 0.60, 0.86]，< 0.001）。
在预测MCI和MCI/痴呆症风险方面，就诊间血压变异性优于TTR。在强化治疗下，TTR与痴呆症风险的关联更为密切。研究结果在血压严格控制的队列中独立于平均血压，提示血压控制的新方面可能有助于进一步降低认知风险。
ClinicalTrials.gov；NCT01206062。
