# Preventing Cognitive Decline by Reducing BP Target Trial (PCOT)

> **NIH NIH R61** · UT SOUTHWESTERN MEDICAL CENTER · 2020 · $796,575

## Abstract

SPRINT,5 and its accompanying cognitive-focused substudy SPRINT-MIND recently showed that blood
pressure control (goal SBP<120 mm Hg) reduced incident mild cognitive impairment as well as a combined
outcome of MCI and dementia. Divergence in opinion among experts and professional societies about BP goals
still remain due to the concerns of potential harms. There is a clear need to implement new practical approaches
to control blood pressure in clinical practice and test their effectiveness. Pragmatic clinical trials embedded in
health systems (ePCTs) offer a unique opportunity to study the effectiveness of implementation of evidence-
based interventions in real-world clinical settings. Our team is currently conducting ICD-Pieces
(NCT02587936), the largest ePCT in patients with the coexistent chronic conditions of chronic kidney disease,
hypertension and diabetes as part of a demonstration project in the NIH Health Care Systems Research
Collaboratory. We now propose the Preventing Cognitive Decline by Reducing BP Target Trial (PCOT), to
examine the effects of lowering BP to less than 130/80 upon the incidence of cognitive decline and dementia.
Our main hypothesis is that patients who receive care with a collaboratory model that combines clinical
decision support and team-based care delivered in primary care practices will have better blood
pressure control and a lower incidence of mild cognitive impairment and dementia than patients
receiving usual medical care.
 In the Planning Phase (R61) of this proposal we will build on our existing research infrastructure for
pragmatic clinical trials to establish a collaboratory with 5 large health systems to conduct an ePCT to improve
blood pressure control among adults with hypertension. We will develop readiness to deliver patient-centered
processes to improve blood pressure control and to test for cognitive decline and dementia. In the
Implementation Phase (R33) we will conduct a randomized pragmatic clinical trial to determine the impact
of clinical decision support and team-based BP management in primary care practices compared to usual care
on cognitive impairment and dementia. We will assess the benefits and harms of BP lowering as well as its
impact on quality of life and patient-centered outcomes.
 The existent research infrastructure and lessons learned from ongoing work of our team conducting
pragmatic trials in diverse health systems serving ethnically and socioeconomic diverse patients provide a firm
foundation for the current study. This trial is pragmatic with evidence-based interventions informed by patients
and delivered in primary care settings by the clinical teams of the health systems using information technology
tools. The outcomes are relevant to major stakeholders including patients, families, clinicians and health
systems. Lessons learned from this trial should be generalizable to other health settings to improve BP control
and test optimal strategies to reduce cognitive impairment ...

## Key facts

- **NIH application ID:** 10045903
- **Project number:** 1R61AG068486-01
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** MIGUEL A VAZQUEZ
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $796,575
- **Award type:** 1
- **Project period:** 2020-09-01 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10045903

## Citation

> US National Institutes of Health, RePORTER application 10045903, Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) (1R61AG068486-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10045903. Licensed CC0.

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