News > Medscape Medical News > Neurology News No Effect on Cognition of BP, Lipid Reduction: HOPE-3 Published Sue Hughes February 28, 2019 first presented at the American Heart Association Scientific Sessions in 2016, showed no effect of either treatment strategy on cognitive decline, results of an exploratory analysis suggest some slowing of cognitive decline in the highest risk group. The cognition results were published online yesterday in Neurology. "On first look, our results do not suggest a benefit of lowering blood pressure on cognitive function. However, when we dig deeper in post hoc analysis, there does appear to be some benefit of treatment in those at higher risk," lead author Jackie Bosch, PhD, McMaster University, Hamilton, Canada, commented to Medscape Medical News. She points out that this fits in with the SPRINT MIND study that showed there was a slowing of cognitive decline in the more aggressive blood-pressure lowering group. "The SPRINT trial involved a much higher risk population, with all patients having hypertension, and the trial investigated different treatment targets," Bosch noted. "HOPE-3 involved a population at moderate cardiovascular risk, but most participants did not actually have raised blood pressure." Their aim was to see if an across-the-board strategy of lowering blood pressure at a certain cardiovascular risk level would have a benefit on cognition — even if the participants were not hypertensive at baseline, she said. "The theory behind this is that, as we know raised blood pressure is very closely tied to stroke and TIA, we thought that in patients with vascular dysfunction the reduced stress on the vessel wall could improve perfusion in the brain and reduce subclinical strokes, and therefore cognitive decline. But we didn’t find that to be the case, which was disappointing," Bosch said. They did however, see something in the highest risk group of patients who did have raised blood pressure at baseline. "This suggests the negative effects of blood pressure in individuals at moderate cardiovascular risk are only evident in those with pressures over the hypertension threshold." Noting that the cognition study only included individuals aged 70 or over, Bosch said: "Our results could suggest that if you have got to 70 [years old] with a normal blood pressure, you probably won't get major vascular issues such as stroke and cognitive decline secondary to increased blood pressure in [the] future." Neutral Lipid Results – Good News? On the null results with lipid lowering overall, Bosch said: "Cholesterol does not have such a strong relationship with stroke as blood pressure has, so perhaps it was a long shot hoping for a reduction in cognitive decline by lowering cholesterol. But while we would have liked to see a benefit on cognitive decline with the statin, the fact that we saw no difference is still a positive result."
