Effect of lowering blood pressure on risk for cognitive decline in patients with diabetes

February 3, 2014

Intensive blood pressure and cholesterol lowering was not associated with reduced risk for diabetes-related cognitive decline in older patients with long-standing type 2 diabetes mellitus, according to a study in JAMA Internal Medicine by Jeff D. Williamson, M.D., M.H.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues.

Patients with (T2DM) are at increased risk for decline in cognitive function, for reduced volume and increased white matter lesions on brain imaging, according to the study. The authors examined the effect of intensive treatment to (BP) and lipid levels as part of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

The trial randomized 2,977 participants without baseline cognitive impairment or dementia and with hemoglobin A 1C levels less than 7.5 percent to a systolic BP goal of less than 120 or less than 140 mm Hg (n=1,439) and to a fibrate or placebo in patients with statin-treated, low-density lipoprotein less than 100 mg/dL (n=1,538).

Researchers assessed cognition at baseline, 20 and 40 months. Also, 503 participants underwent baseline and 40-month brain magnetic resonance imaging to look for changes in total brain volume (TBV) and other structural measures of brain health.

There were no differences in cognitive function in the intensive BP-lowering trial (<120 target) or in the fibrate groups. At 40 months, the intensive BP intervention group had a lower TBV compared with the standard BP intervention group. Fibrate therapy had no effect on TBV.

"During the past two decades, the belief that more intensive treatment strategies for controlling T2DM-related comorbidities [related illnesses], such as hyperglycemia, hyperlipidemia and hypertension, would reduce clinical complications has driven large investment in new medications for this disease syndrome," the study concludes. "These results do not negate other evidence that intensive strategies to control BP and lipid levels may be indicated for other conditions such as stroke or coronary heart disease. However, this randomized clinical trial in 2,977 older adults with a mean baseline Mini-Mental State Examination score higher than 27, a mean HbA 1c level of 8.3 percent, and long-term T2DM shows no overall reduction of the rate of T2DM-related cognitive decline through intensive BP therapy or adding a fibrate to well-controlled LDL-C levels."

Explore further: Brain atrophy linked with cognitive decline in diabetes

More information: JAMA Intern Med. Published online February 3, 2014. DOI: 10.1001/jamainternmed.2013.13656

Related Stories

Brain atrophy linked with cognitive decline in diabetes

September 12, 2013
New research has shown that cognitive decline in people with Type 2 Diabetes is likely due to brain atrophy, or shrinkage, that resembles patterns seen in the early stages of Alzheimer's disease.

Blood sugar control beyond standard target doesn't improve cognitive decline for diabetics

September 27, 2011
Intensive control of blood sugar levels beyond standard targets provides no additional protection against cognitive decline in older people with diabetes than standard treatment, according to a national study coordinated ...

Low diastolic blood pressure may be associated with brain atrophy

June 10, 2013
Low baseline diastolic blood pressure (DBP) appears to be associated with brain atrophy in patients with arterial disease, whenever declining levels of blood pressure (BP) over time among patients who had a higher baseline ...

Brain atrophy seen in patients with diabetes

August 23, 2013
(HealthDay)—Brain atrophy rather than cerebrovascular lesions may explain the relationship between type 2 diabetes mellitus (T2DM) and cognitive impairment, according to a study published online Aug. 12 in Diabetes Care.

Single combination pill provides benefit to patients with or at risk of CVD

September 3, 2013
In a randomized trial that included about 2,000 patients with or at high risk of cardiovascular disease (CVD), use of a fixed-dose combination medication for blood pressure, cholesterol, and platelet control compared to usual ...

Heart disease linked with dementia in older postmenopausal women

December 18, 2013
Heart disease may put older postmenopausal women at higher risk for decreased brain function such as dementia, according to new research in Journal of the American Heart Association.

Recommended for you

Diabetes can be tracked with our Google searches

July 26, 2017
The emergence of Type 2 Diabetes could be more effectively monitored using our Google searches—helping public health officials keep track of the disease and halt its spread—according to research by the University of Warwick.

Scientists discover a new way to treat type 2 diabetes

July 21, 2017
Medication currently being used to treat obesity is also proving to have significant health benefits for patients with type 2 diabetes. A new study published today in Molecular Metabolism explains how this therapeutic benefit ...

Alzheimer's drug cuts hallmark inflammation related to metabolic syndrome by 25 percent

July 20, 2017
An existing Alzheimer's medication slashes inflammation and insulin resistance in patients with metabolic syndrome, a potential therapeutic intervention for a highly dangerous condition affecting 30 percent of adults in the ...

Diabetes or its precursor affects 100 million Americans

July 19, 2017
Almost one-third of the US population—100 million people—either has diabetes or its precursor condition, known as pre-diabetes, said a government report Tuesday.

One virus may protect against type 1 diabetes, others may increase risk

July 11, 2017
Doctors can't predict who will develop type 1 diabetes, a chronic autoimmune disease in which the immune system destroys the cells needed to control blood-sugar levels, requiring daily insulin injections and continual monitoring.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

July 7, 2017
For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia - high blood sugar, or hypoglycemia - low blood sugar), says new research published ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.