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Intensive BP Reduction Doesn't Prevent Cognitive Decline
Findings in older patients with existing type 2 diabetes mellitus

TUESDAY, Feb. 4, 2014 (HealthDay News) -- Intensive treatment to lower blood pressure (BP) and cholesterol does not reduce the risk of cognitive decline in patients with type 2 diabetes mellitus (T2DM), according to a study published online Feb. 3 in JAMA Internal Medicine.

Jeff D. Williamson, M.D., from the Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues examined data from a clinical trial involving 2,977 participants without baseline cognitive impairment or dementia and with hemoglobin A1c levels <7.5 percent. Participants were randomized to a systolic BP goal of <120 versus <140 mm Hg (1,439 patients) or to a fibrate versus placebo in patients with low-density lipoprotein cholesterol levels <100 mg/dL (1,538 patients). The authors sought to determine the treatment effects on cognitive decline (assessed at baseline and 20 and 40 months) and total brain volume (TBV) measured with magnetic resonance imaging at baseline and 40 months in patients with T2DM.

The researchers found that at 40 months there were no differences in cognitive function in the intensive BP-lowering trial or in the fibrate trial. At 40 months, TBV had declined more in the intensive group than in the standard BP-lowering group (difference, −4.4 cm³; P = 0.01). Compared to placebo, fibrate therapy had no effect on TBV.

"In participants with long-standing T2DM and at high risk for cardiovascular events, intensive BP control and fibrate therapy in the presence of controlled low-density lipoprotein cholesterol levels did not produce a measurable effect on cognitive decline at 40 months of follow-up," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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