Clinical trials in vascular cognitive impairment following SPRINT-MIND: An international perspective

Fanny M. Elahi, Suvarna Alladi, Sandra E. Black, Jurgen A.H.R. Claassen, Charles DeCarli, Timothy M. Hughes, Justine Moonen, Nicholas M. Pajewski, Brittani R. Price, Claudia Satizabal, C. Elizabeth Shaaban, Nárlon C.B.S. Silva, Heather M. Snyder, Lukas Sveikata, Jeff D. Williamson, Frank J. Wolters, Atticus H. Hainsworth

Research output: Contribution to journalReview articlepeer-review


A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.

Original languageEnglish
Article number101089
JournalCell Reports Medicine
Issue number6
StatePublished - 20 Jun 2023


  • aging
  • blood pressure
  • clinical trials
  • cognitive impairment
  • dementia
  • hypertension
  • prevention
  • vascular disease


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