Intensive BP-Lowering Didn’t Affect Cognitive Function in Diabetes

by U.S. Medicine

April 2, 2014
WINSTON-SALEM, NC — A decline in cognitive function, reduced brain volume and increased white matter lesions are all risks for patients with type 2 diabetes mellitus (T2DM), especially with high blood pressure and lipid levels. In light of that, a newly-published study sought to determine whether intensive therapy for hypertension and combination therapy with a statin plus a fibrate reduces the risk of decline in cognitive function and total brain volume (TBV) in patients with T2DM.1 The study, led by researchers from Wake Forest University and including participation from the Naval Medical Center in San Diego, involved 2,977 participants without baseline clinical evidence of cognitive impairment or dementia and with hemoglobin A1c (HbA1c) levels less than 7.5%. The group was randomized to a systolic BP goal of less than 120 vs. less than 140 mm Hg in 1,439 participants, or to a fibrate vs. placebo in 1,538 patients with low-density lipoprotein cholesterol levels less than 100 mg/dL. Study participants were recruited at North American medical clinics from Aug. 1, 2003, through Oct. 31, 2005, with the final follow-up visit by June 30, 2009. Cognition was assessed at baseline and 20 and 40 months, with a subset of 503 participants undergoing baseline and 40-month brain magnetic resonance imaging to assess for change in TBV and other structural measures of brain health. At 40 months, no differences in cognitive function were found in the intensive BP-lowering trial or in the fibrate trial, according to the study. TBV had declined more in the intensive vs. standard BP-lowering group (difference, -4.4 [95% CI, -7.8 to -1.1] cm3; P = 0.01). Fibrate therapy had no effect on TBV compared with placebo. “In participants with long-standing T2DM and at high risk for cardiovascular events, intensive BP control and fibrate therapy in the presence of controlled low-density lipoprotein cholesterol levels did not produce a measurable effect on cognitive decline at 40 months of follow-up,” the authors wrote. “Intensive BP control was associated with greater decline in TBV at 40 months relative to standard therapy.” 1Williamson JD, Launer LJ, Bryan RN, Coker LH, Lazar RM, Gerstein HC, Murray AM, Sullivan MD, Horowitz KR, Ding J, Marcovina S, Lovato L, Lovato J, Margolis KL, Davatzikos C, Barzilay J, Ginsberg HN, Linz PE, Miller ME; Action to Control Cardiovascular Risk in Diabetes (ACCORD) Memory in Diabetes (MIND) Investigators. Cognitive function and brain structure in persons with type 2 diabetes mellitus after intensive lowering of blood pressure and lipid levels: a randomized clinical trial. JAMA Intern Med. 2014 Mar 1;174(3):324-33. doi: 10.1001/jamainternmed.2013.13656. PubMed PMID: 24493100.

Related Articles

VHA’s Type 1 Diabetes Telehealth Care Saves Time, Money

About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.

VHA Data Helps Validate Tool for Hypoglycemia Risk ID

OAKLAND, CA—Data from more than 1.3 million VHA patients was used to help validate a practical tool for identifying people with diabetes who are at the highest risk for being admitted to an emergency department... View Article


U.S. Medicine Recommends


More From diabetes

Diabetes

VHA’s Type 1 Diabetes Telehealth Care Saves Time, Money

About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.

Diabetes

VHA Data Helps Validate Tool for Hypoglycemia Risk ID

SILVER SPRING, MD — New cases of acute and chronic hepatitis C (HCV) have dropped sharply among U.S. servicemembers since 2008, bucking the nationwide trend. For the general population, the national Centers for Disease Control... View Article

Diabetes

Hypoglycemia Common in Hospice Patients Continuing Insulin Treatment

SILVER SPRING, MD — New cases of acute and chronic hepatitis C (HCV) have dropped sharply among U.S. servicemembers since 2008, bucking the nationwide trend. For the general population, the national Centers for Disease Control... View Article

Diabetes

VA Study Shows Kidney Disease Ups Diabetes Risk

SILVER SPRING, MD — New cases of acute and chronic hepatitis C (HCV) have dropped sharply among U.S. servicemembers since 2008, bucking the nationwide trend. For the general population, the national Centers for Disease Control... View Article

Diabetes

VA Study Finds Older Medicare Patients Often Are Overtreated for Diabetes

It’s not only the VA that struggles with the balance between just enough treatment of older Type 2 diabetes patients and too much.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up