Aged Care Insite Issue 111 | Feb-March 2019 | Seite 31

clinical focus
could not, at this stage, be generalised. However, Yaffe found the
study to be an overall positive step in finding a dementia prevention.
“For older adults, almost all of whom have concerns about being
diagnosed with Alzheimer’s disease and related dementia, [the
SPRINT trial] offers great hope. [It] demonstrates that among those
with hypertension, intensive systolic blood pressure control can
reduce the development of cognitive impairment,” she said.
Dementia hope
Blood pressure treatment a “major leap” forward
in dementia research.
By Conor Burke
I
n what could be a significant development in the study of
dementia and other cognitive impairments, an American study
has found that among those with hypertension, intensive systolic
blood pressure control can reduce the likelihood of mild cognitive
impairment, which often leads to dementia.
Part of the wider SPRINT trial (Systolic Blood Pressure
Intervention), the randomised clinical trial was conducted at 102
sites in the US and Puerto Rico among adults aged 50 years or older.
According to the Heart Foundation, as of 2014–15, about 6 million
Australians (34 per cent) aged 18 or older had high blood pressure
(systolic blood pressure 140mmHg or higher) with the percentage
creeping up to 41.5 per cent for over-65s.
The trial looked at the effect of intensive blood pressure control
treatment (systolic blood pressure of 120mmHg or lower) on
the probability of dementia and mild cognitive impairment in
comparison with those treated with a blood pressure goal of
140mmHg or lower (standard treatment group), as previous
observational studies have shown that hypertension (which affects
35 per cent of Australians over 55) is a risk factor for both conditions.
EXCITING STEP
Yaffe added that the “study may not be the final approach for the
prevention of Alzheimer’s disease or other cognitive impairments,
but it represents a major leap forward in what has emerged as a
marathon journey”.
Associate Professor Gideon Caplan, director of geriatric medicine
at the Prince of Wales Hospital in Sydney, said: “It’s a very exciting
result, being the first study to show an effect caused by lowering
blood pressure on cognitive function.
“It’s not a ‘slam dunk’ result,” he warns, “because there was no
significant effect of intensive blood pressure control on dementia,
but intensive blood pressure control did reduce mild cognitive
impairment and the combined outcome of mild cognitive
impairment and dementia. But the study did stop early because of
the positive effect on cardiovascular events.
“This builds on what we already knew, that vascular risk factors
like high blood pressure and smoking are associated with more
frequent dementia,” he said. ■
Slip Resistant Safety Socks
Suitable for Hospitals & Health Facilities
lessening the risk of patients falling
DESIGN INFORMATION:
Sizes Regular & Large
RESULTS
During a total median follow-up of 5.11 years, adjudicated probable
dementia occurred in 149 participants in the intensive treatment
group versus 176 in the standard treatment group (7.2 vs 8.6
cases per 1000 person-years). Intensive blood pressure control
significantly reduced the risk of mild cognitive impairment (14.6 vs
18.3 cases per 1000 person-years) and the combined rate of mild
cognitive impairment or probable dementia (20.2 vs 24.1 cases per
1000 person-years).
The study had some drawbacks. Firstly, it was stopped early for
ethical reasons: as the benefits of dropping blood pressure below
120 had such a positive effect on the likelihood of cardiovascular
events and death, the researchers felt that those being treated at the
higher blood pressure rate needed to be informed.
Furthermore, in her editorial on the paper, Dr Kristine Yaffe from
the University of California, San Francisco, wrote that information to
compare the effects of different classes of antihypertensive drugs
on cognitive outcomes was not provided, and that questions remain
as to what age is best to treat elevated systolic blood pressure and
whether the same care should be administered to all ages.
Yaffe also noted that as participants who had diabetes, stroke or
symptomatic heart failure were excluded from the trial, the findings
75% Cotton, 25% Spandex
Double sided safety dots
No elastic for better circulation
$2-20
EXCL. GST
ENQUIRE NOW
[e-mail]
TEL: [phone]
WWW.HARRYSSHOESPLUS.COM.AU
FAX: [phone]
agedcareinsite.com.au 29