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

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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.

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  1. Denise Feil says:

    The subjects and controls at baseline were not a patient population typically at risk for developing cognitive impairment and the duration of the study was too short for the intervention to demonstrate a preventive effect relative to the control group.

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