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Functional health and white matter hyperintensities as effect modifiers of blood pressure-lowering on cognitive function and vascular events in older Secondary Prevention of Small Subcortical Strokes trial participants
Journal article   Open access   Peer reviewed

Functional health and white matter hyperintensities as effect modifiers of blood pressure-lowering on cognitive function and vascular events in older Secondary Prevention of Small Subcortical Strokes trial participants

Manuel R. Blum, Rebecca Scherzer, Jesse C. Ikeme, Oscar R. Benavente, Leslie A. McClure, Carmen A. Peralta and Michelle C. Odden
Journal of hypertension, v 38(8), pp 1578-1585
01 Aug 2020
DOI: https://doi.org/10.1097/HJH.0000000000002440
PMID: 32371759
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1097/hjh.0000000000002440View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Cardiovascular System & Cardiology Life Sciences & Biomedicine Peripheral Vascular Disease Science & Technology
Objective: To determine whether cerebral small vessel disease or disability modify the effect of SBP treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke. Methods: Participants aged at least 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149 mmHg) or lower (<130 mmHg) SBP target. The primary outcome was change in cognitive function (Cognitive Abilities Screening Instrument); secondary outcomes were incident mild cognitive impairment, stroke, major vascular events (all-stroke, myocardial infarction), and all-cause death. Results were stratified by severity of white matter hyperintensities (WMH; none/mild, moderate, severe) on baseline MRI, and by disability (no vs. at least one limitation in activities of daily living). Results: One thousand, two hundred and sixty-three participants (mean age 73.8 +/- 5.9 years, 40% women) were included. Participants with severe WMH or disability had worse cognitive function at baseline and after a mean follow-up of 3.9 years. No significant interactions existed between treatment group and effect modifiers (WMH, disability) for change in cognitive function (Pfor interaction 0.42 and 0.66, respectively). A lower SBP target appeared more beneficial among those with worse WMH burden for vascular outcomes (Pfor interaction = 0.01 for stroke and 0.03 for major vascular events). Conclusion: There was no difference in the effect of lowering SBP to less than 130 mmHg on cognitive function by cerebral small vessel disease or disability among older adults with a history of lacunar stroke. Those with evidence of small vessel disease may derive greater benefit from lower SBP on prevention of subsequent vascular events.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Domestic collaboration
International collaboration
Web of Science research areas
Peripheral Vascular Disease
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