Hypertension is a risk factor for dementia, although some observational studies suggest an association between low blood pressure and cognitive impairment. The development of dementia, determined using in-person standardized cognitive assessments, was evaluated in more than 9000 hypertensive adults in the Systolic Pressure Intervention Trial (SPRINT) who were randomly assigned to a more intensive (systolic pressure <120 mmHg) or less intensive (systolic pressure <140 mmHg) goal blood pressure . At five years, the rates of dementia and of mild cognitive impairment were slightly lower in the more intensive group, although the effect on dementia risk was not statistically significant. These findings suggest that intensive blood pressure lowering does not increase, and may reduce, the risk of dementia.
(See "Goal blood pressure in adults with hypertension", section on 'Patients with established atherosclerotic cardiovascular disease'.)
1. SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA 2019; 321:553.
White coat hypertension is defined as elevated office blood pressure with normal out-of-office blood pressure readings, and white coat effect is defined as elevated office blood pressure in a patient treated for hypertension with normal out-of-office readings. The risks associated with white coat hypertension and white coat effect are unclear. In a meta-analysis of 27 studies comparing cardiovascular outcomes of patients with white coat hypertension or effect versus normotensive patients, white coat hypertension was associated with an increased risk of cardiovascular and all-cause mortality, and a nonsignificantly higher risk of all cardiovascular events . In contrast, white coat effect was not associated with increased risk. While we do not initiate pharmacologic treatment for white coat hypertension, lifestyle modification should be encouraged and out-of-office blood pressure measurements monitored for the development of worsening or sustained hypertension.
1. Cohen JB, Lotito MJ, Trivedi UK, et al. Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis. Ann Intern Med 2019.
Whether marijuana use during pregnancy impacts obstetric outcomes has been unclear because of conflicting data, small study sizes, and multiple confounding factors (eg, tobacco and other substance use). In a population-based retrospective cohort study comparing over 9000 prenatal cannabis users with nonusers, cannabis use was associated with twice the rate of preterm birth <37 weeks of gestation (12 versus 6 percent), and increased rates of small for gestational age, placental abruption, transfer to neonatal intensive care, and 5-minute Apgar score less than 4/10 . Despite the limitations of retrospective observational data, these findings from a large study are concerning and support recommendations to avoid marijuana use while pregnant.
1. Corsi DJ, Walsh L, Weiss D, et al. Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes. JAMA 2019.
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