Blood pressure control as an intervention to prevent dementia

Observational findings of a relationship between blood pressure during midlife and cognitive brain outcomes have been replicated in different populations, but negative findings have also been reported.1 Often based on cross-sectional studies or on data from very old people (ie, >80 years of age), interpretations of these negative studies have not accounted for issues such as reverse causation.2 As a consequence of inconsistencies in the published literature, blood pressure lowering has not been accepted as a candidate for intervention against cognitive impairment or dementia—a trial was needed. The SPRINT MIND trial detected a cognitive benefit of blood pressure lowering in a large cohort of people aged 50 years and older with diverse ethnic origins.3 This trial strengthens the observational study conclusions that blood pressure is involved in modulating risk for dementia and underlines the importance of linking findings in risk factors during middle age with outcomes in older people. Immediate attention should be given to efforts to control blood pressure through clinical services and public health interventions, and to alleviate the barriers to delivery and uptake of these public-health messages.6 Life in View/SPL I declare no competing interests.