• Chao Jiang, Manlin Zhao, Mingxiao Li, Zhiyan Wang, Yu Bai, Hang Guo, Sitong Li, Yiwei Lai, Yufeng Wang, Mingyang Gao, Liu He, Xueyuan Guo, Songnan Li, Nian Liu, Chenxi Jiang, Ribo Tang, Deyong Long, Caihua Sang, Xin Du, Jianzeng Dong, Craig S Anderson, and Changsheng Ma.
• Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Chaoyang, Beijing, China.
• J. Intern. Med. 2024 Apr 1; 295 (4): 557568557-568.

BackgroundEffects of intensive blood pressure (BP) control on cognitive outcomes in patients with excess orthostatic BP changes are unclear. We aimed to evaluate whether orthostatic BP changes modified the effects of BP intervention on cognitive impairment.MethodsWe analyzed 8547 participants from the Systolic Blood Pressure Intervention Trial Memory and cognition IN Decreased Hypertension. Associations between orthostatic BP changes and incident cognitive outcomes were evaluated by restricted cubic spline curves based on Cox models. The interactions between orthostatic BP changes and intensive BP intervention were assessed.ResultsThe U-shaped associations were observed between baseline orthostatic systolic BP changes and cognitive outcomes. However, there were insignificant interactions between either change in orthostatic systolic BP (P for interaction = 0.81) or diastolic BP (P for interaction = 0.32) and intensive BP intervention for the composite outcome of probable dementia or mild cognitive impairment (MCI). The hazard ratio of intensive versus standard target for the composite cognitive outcome was 0.82 (95% CI 0.50-1.35) in those with an orthostatic systolic BP reduction of >20 mmHg and 0.41 (95% CI 0.21-0.80) in those with an orthostatic systolic BP increase of >20 mmHg. Results were similar for probable dementia and MCI. The annual changes in global cerebral blood flow (P for interaction = 0.86) consistently favored intensive BP treatment across orthostatic systolic BP changes.ConclusionIntensive BP control did not have a deteriorating effect on cognitive outcomes among hypertensive patients experiencing significant postural BP changes.© 2023 The Association for the Publication of the Journal of Internal Medicine.

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