Intensive blood pressure and cholesterol lowering was not associated with a reduced risk of cognitive decline in older patients (mean age 62 years) with longstanding type 2 diabetes mellitus, a study has found. Patients with type 2 diabetes are at increased risk of decline in cognitive function, reduced brain volume, and increased white matter lesions on brain imaging, says background information given in the paper. Preliminary studies have indicated that intensive treatment to control blood pressure and lipid concentrations may prevent some of this cognitive decline, and the authors set out to test this hypothesis.

The study, published in JAMA Internal Medicine, showed that there were no differences in cognitive function between patients who received intensive treatment to lower blood pressure (<120 target) or standard treatment and those treated with a fibrate or placebo. The authors concluded, “During the past two decades, the belief that more intensive treatment strategies for controlling T2DM related comorbidities, such as hyperglycemia, hyperlipidemia and hypertension, would reduce clinical complications has driven large investment in new medications for this disease syndrome.“These results do not negate other evidence that intensive strategies to control BP and lipid levels may be indicated for other conditions such as stroke or coronary heart disease. However, this randomized clinical trial shows no overall reduction of the rate of T2DM-related cognitive decline through intensive BP therapy or adding a fibrate to well-controlled LDL-C levels.”