Levine Deborah A, Sussman Jeremy B, Hayward Rodney A, Gałecki Andrzej T, Whitney Rachael T, Briceño Emily M, Gross Alden L, Giordani Bruno J, Elkind Mitchell Sv, Gottesman Rebecca F, Gaskin Darrell J, Sidney Stephen, Yaffe Kristine, Burke James F
Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.
J Alzheimers Dis. 2025 Jan;103(2):506-518. doi: 10.1177/13872877241302506. Epub 2025 Jan 8.
Black adults have higher dementia risk than White adults. Whether tighter population-level blood pressure (BP) control reduces this disparity is unknown.
Estimate the impact of optimal BP treatment intensity on racial disparities in dementia.
A microsimulation study of US adults ≥18 across a life-time policy-planning horizon. BP treatment strategies were the Systolic Blood Pressure Intervention Trial (SPRINT) protocol, the Eighth Joint National Committee (JNC-8) recommendations, and usual care (non-intervention control). Outcomes were all-cause dementia, atherosclerotic cardiovascular disease (ASCVD), stroke, myocardial infarction, non-ASCVD death, global cognitive performance, and optimal brain health (being free of dementia, cognitive impairment, or stroke). Population-level and individual-level effects stratified by race were estimated.
Optimal population-level implementation of a SPRINT-based BP treatment strategy, compared to usual care, would average annual dementia incidence in White, but not Black, adults (1% versus 0%), due to hypertensive individuals' greater survival, and reduce annual ASCVD events more in Black than White adults (13% versus 5%). Under a SPRINT-based strategy, individuals with hypertension gained more years lived without dementia, ASCVD, myocardial infarction, or stroke and more years lived in optimal brain health. A SPRINT-based strategy did not attenuate individual-level race disparities in outcomes, except stroke. Due to longer life expectancy, a SPRINT-based strategy did not substantially reduce lifetime dementia risk in either group. The JNC-8-based strategy had similar but smaller effects as the SPRINT-based strategy.
Our results suggest that tighter population-level BP control would not reduce population-level disparities in dementia between US Black and White adults.
黑人成年人患痴呆症的风险高于白人成年人。人群层面更严格的血压控制是否能缩小这一差距尚不清楚。
评估最佳血压治疗强度对痴呆症种族差异的影响。
一项针对美国18岁及以上成年人的微观模拟研究，研究跨越终身政策规划期。血压治疗策略采用收缩压干预试验（SPRINT）方案、美国国家联合委员会第八次报告（JNC - 8）建议以及常规治疗（非干预对照）。结局指标包括全因性痴呆、动脉粥样硬化性心血管疾病（ASCVD）、中风、心肌梗死、非ASCVD死亡、整体认知功能以及最佳脑健康状态（无痴呆、认知障碍或中风）。估计了按种族分层的人群层面和个体层面的影响。
与常规治疗相比，基于SPRINT的血压治疗策略在人群层面的最佳实施，将使白人成年人（而非黑人成年人）的年痴呆症发病率平均降低（1%对0%），这是由于高血压患者的生存率提高，并且黑人成年人每年的ASCVD事件减少幅度比白人成年人更大（13%对5%）。在基于SPRINT的策略下，高血压患者在无痴呆、ASCVD、心肌梗死或中风的情况下存活的年数增加，并且在最佳脑健康状态下存活的年数增加。基于SPRINT的策略除了中风外，并未减弱个体层面结局的种族差异。由于预期寿命较长，基于SPRINT的策略并未显著降低两组人群的终生痴呆症风险。基于JNC - 8的策略与基于SPRINT的策略效果相似，但影响较小。
我们的结果表明，人群层面更严格的血压控制不会缩小美国黑人和白人成年人在痴呆症方面的人群层面差异。
