Cardiometabolic Renal Health Profile, Intensive Blood Pressure-Lowering Treatment and Cognitive Dysfunction: A Post Hoc Analysis of the SPRINT Trial.

BACKGROUND: Whether participants with different cardiometabolic renal health profiles would derive comparable cognitive benefits from intensive blood pressure (BP)-lowering treatment remains underexplored. METHODS: This post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) derived a cardiometabolic renal health profile based on baseline levels of fasting plasma glucose, non-high-density lipoprotein cholesterol, estimated glomerular filtration rate, urine albumin-to-creatinine ratio and history of subclinical and clinical cardiovascular disease. Participants were categorised into tertiles (favourable, intermediate and poor) based on the distribution of the risk-weighted profile. Cognitive outcomes included probable dementia, mild cognitive impairment (MCI) and a composite of the two. RESULTS: A total of 8162 participants (mean age 67.8 years; 35.2% women) with complete baseline profile data were included. In exploratory tertile-based analyses, intensive BP-lowering treatment was associated with a lower risk of MCI among participants with favourable profiles (adjusted HR 0.64, 95% CI 0.48-0.86), with the largest absolute risk difference observed in this group (adjusted ARD, -3.05%; 95% CI, -4.85% to -1.24%) and a significant interaction on the ARD scale (p for interaction = 0.039). No interaction was observed for the other cognitive outcomes or adverse events. CONCLUSIONS: Intensive BP-lowering treatment tended to be associated with greater absolute risk reductions for MCI among participants with favourable cardiometabolic renal health profiles. These findings should be considered exploratory and require validation in future studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01206062.