Association of Intensive vs Standard Blood Pressure Control With Magnetic Resonance Imaging Biomarkers of Alzheimer Disease: Secondary Analysis of the SPRINT MIND Randomized Trial.
Association of Intensive vs Standard Blood Pressure Control With Magnetic Resonance Imaging Biomarkers of Alzheimer Disease: Secondary Analysis of the SPRINT MIND Randomized Trial.
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DOI：
10.1001/jamaneurol.2021.0178
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发表时间：
2021-05-01
期刊：
影响因子：
29
通讯作者：
SPRINT Research Group
中科院分区：
文献类型：
--
作者：
Nasrallah IM;Gaussoin SA;Pomponio R;Dolui S;Erus G;Wright CB;Launer LJ;Detre JA;Wolk DA;Davatzikos C;Williamson JD;Pajewski NM;Bryan RN;SPRINT Research Group
随机临床试验的荟萃分析表明，改善高血压控制可降低认知障碍和痴呆的风险。然而，目前尚不清楚高血压控制在多大程度上影响了反映阿尔茨海默病（AD）病理学的途径。评估强化血压控制与AD相关脑生物标志物的相关性。这是一项多中心随机临床试验，比较了2种不同降压策略的疗效。潜在的参与者（n = 1267）50岁或以上的高血压和无糖尿病或中风史的脑磁共振成像（MRI）研究。其中，205名参与者被认为不合格，269名不同意参与; 673名和454名参与者分别在基线和4年随访时完成了脑部MRI;最终随访日期为2016年7月1日。分析从2019年9月开始至2020年11月结束。参与者被随机分配到收缩压目标低于120 mm Hg（强化治疗：n = 356）或低于140 mm Hg（标准治疗：n = 317）。海马体积的变化，AD区域萎缩的测量，后扣带回脑血流和扣带回束的平均各向异性分数。在招募的673例接受基线MRI的患者中（平均[SD]年龄，67.3 [8.2]岁; 271例女性[40.3%]），454例在随机化后中位数（四分位距）3.98（3.7-4.1）年时完成随访MRI。在强化治疗组中，平均海马体积从7.45 cm 3降至7.39 cm 3（差异，−0.06 cm 3; 95% CI，−0.08至−0.04）vs从7.48 cm 3降至7.46 cm 3标准治疗组（差异，−0.02 cm 3; 95% CI，−0.05至−0.003）（变化的组间差异，-0.033 cm 3; 95%CI，-0.062至-0.003; P = .03）。AD区域萎缩、脑血流量或平均各向异性分数的测量结果在治疗组间无显著差异。与标准治疗相比，强化治疗与海马体积的较小但具有统计学显著性的较大降低相关，这与强化治疗与总脑体积的较大降低相关的观察结果一致。然而，与标准治疗相比，强化治疗与AD的任何其他MRI生物标志物的变化无关。ClinicalTrials.gov标识符：NCT 01206062
Meta-analyses of randomized clinical trials have indicated that improved hypertension control reduces the risk for cognitive impairment and dementia. However, it is unclear to what extent pathways reflective of Alzheimer disease (AD) pathology are affected by hypertension control. To evaluate the association of intensive blood pressure control on AD-related brain biomarkers. This is a substudy of the Systolic Blood Pressure Intervention Trial (SPRINT MIND), a multicenter randomized clinical trial that compared the efficacy of 2 different blood pressure–lowering strategies. Potential participants (n = 1267) 50 years or older with hypertension and without a history of diabetes or stroke were approached for a brain magnetic resonance imaging (MRI) study. Of these, 205 participants were deemed ineligible and 269 did not agree to participate; 673 and 454 participants completed brain MRI at baseline and at 4-year follow-up, respectively; the final follow-up date was July 1, 2016. Analysis began September 2019 and ended November 2020. Participants were randomized to either a systolic blood pressure goal of less than 120 mm Hg (intensive treatment: n = 356) or less than 140 mm Hg (standard treatment: n = 317). Changes in hippocampal volume, measures of AD regional atrophy, posterior cingulate cerebral blood flow, and mean fractional anisotropy in the cingulum bundle. Among 673 recruited patients who had baseline MRI (mean [SD] age, 67.3 [8.2] years; 271 women [40.3%]), 454 completed the follow-up MRI at a median (interquartile range) of 3.98 (3.7–4.1) years after randomization. In the intensive treatment group, mean hippocampal volume decreased from 7.45 cm3 to 7.39 cm3 (difference, −0.06 cm3; 95% CI, −0.08 to −0.04) vs a decrease from 7.48 cm3 to 7.46 cm3 (difference, −0.02 cm3; 95% CI, −0.05 to −0.003) in the standard treatment group (between-group difference in change, −0.033 cm3; 95% CI, −0.062 to −0.003; P = .03). There were no significant treatment group differences for measures of AD regional atrophy, cerebral blood flow, or mean fractional anisotropy. Intensive treatment was associated with a small but statistically significant greater decrease in hippocampal volume compared with standard treatment, consistent with the observation that intensive treatment is associated with greater decreases in total brain volume. However, intensive treatment was not associated with changes in any of the other MRI biomarkers of AD compared with standard treatment. ClinicalTrials.gov Identifier: NCT01206062
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影响因子：
4.3
作者：
Klein A;Tourville J
通讯作者：
Tourville J
DOI：
10.1177/1740774514537404
发表时间：
2014-10
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Ambrosius WT;Sink KM;Foy CG;Berlowitz DR;Cheung AK;Cushman WC;Fine LJ;Goff DC Jr;Johnson KC;Killeen AA;Lewis CE;Oparil S;Reboussin DM;Rocco MV;Snyder JK;Williamson JD;Wright JT Jr;Whelton PK;SPRINT Study Research Group
通讯作者：
SPRINT Study Research Group
影响因子：
1.9
作者：
Liu Q;Li C;Wanga V;Shepherd BE
通讯作者：
Shepherd BE
影响因子：
14
作者：
通讯作者：
--
影响因子：
4.2
作者：
Jeon, So Yeon;Byun, Min Soo;Lee, Dong Young
通讯作者：
Lee, Dong Young