Fifteen years ago, I fell in love with neuroscience as an undergraduate studying memory and attention in the labs of Ken Paller and Marcia Grabowecky at Northwestern University. This passion led me to medical school, and eventually, to become a neurologist. In the intervening years, I have spent a lot of time thinking about what the pharmaceutical industry refers to as a wasteland of failed drug development programs – neurodegenerative disease.
I have also spent a lot of time thinking about a disease that seems, at first glance, unrelated to brain health – hypertension. Hypertension is known as a silent killer, because its symptoms often go unnoticed until it causes a serious health event. According to the Centers for Disease Control and Prevention, about 75 million (1 in 3) Americans has hypertension. Only half of these individuals have their condition under control.
Recently, a new study confirmed what many of us in the neurology community have long suspected: that the seemingly disparate conditions of hypertension and neurodegenerative disease are very closely connected. The study demonstrated that controlling high blood pressure may not just reduce the risk of stroke, but also prevent dementia.
Six months ago, scientists revealed the results of the SPRINT MIND trial, a subset of a large cardiovascular study called SPRINT that began in 2010 and looked at the impact of aggressive blood pressure reduction on brain health. The original SPRINT trial was published while I was still a stroke fellow at the University of California, San Francisco.1 It demonstrated that as a community, physicians were far too conservative in treating blood pressure, and that aggressive treatment of hypertension resulted in significant benefits to heart health.
The results of the original SPRINT trial inspired me to start a company, Sentinel Healthcare, which tackles hypertension head on by remotely monitoring hypertension and accelerating care. Sentinel’s goal is to help people with hypertension reach blood pressure control more rapidly than if they relied on primary care visits alone.
As both a neurologist and the CEO of Sentinel, I had been eagerly awaiting the results from the follow-up trial, SPRINT MIND. I expected that they would be as revealing as the results of the original trial, and support both my philosophy of care and Sentinel’s work in addressing high blood pressure. I believe that controlling high blood pressure has a significant impact on whole-body health, including brain health.
The results from SPRINT MIND are even more astonishing than I expected. People who received intensive treatment for high blood pressure experienced a reduction in mild cognitive impairment (MCI), the predecessor to Alzheimer’s. More importantly, the trial demonstrated these results in just a few years. In fact, the study was so successful at reducing heart attack and stroke that it was ended early; it was deemed unethical not to inform the control group of the benefits of working to lower their blood pressure.
Neurologists believe that patients in the SPRINT MIND trial had lower rates of MCI because they experienced lower rates of vascular dementia. Vascular dementia is an insidious disease that often goes undiagnosed. Most people who are affected by it do not know they have the condition. It results from tiny, unnoticed strokes that are often only detectable by an MRI, and ultimately causes memory loss over time.
Controlling blood pressure is the single most effective way to preventing these tiny strokes, and, in turn, preventing vascular dementia. For this reason, it is imperative we provide more preventative strategies for hypertension care.
Additional recent studies further support this approach. A study out of Rush University looked at autopsies of elderly individuals without diagnosed dementia and found that people with higher blood pressure had significantly more neurofibrillary tangles, a hallmark of Alzheimer’s Disease, even when accounting for genetic risks and risk factors like antihypertensive medication use.2 There were more strokes, too, associated with elevated blood pressure.
The neurology community is now grasping that hypertension and Alzheimer’s are more linked than we ever imagined. Indeed, high blood pressure, along with an individual’s genetics, diet, education, and other risk factors, likely speeds up progression of the disease.
Although the medical community is a long way away from from developing a one-size-fits-all, blockbuster pill that prevents and treats Alzheimer’s, I hope that the SPRINT and SPRINT MIND results will light a fire under all of us to more directly address the implications of high blood pressure on neurodegenerative disease.
I plan to play my part by continuing to help patients achieve hypertension control as an effective strategy for preventing mild cognitive impairment, both in my practice as a neurologist and through my company, Sentinel Healthcare .
1. A Randomized Trial of Intensive versus Standard Blood-Pressure Control, NEJM, 2016
2. Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology, Neurology, 2019