Cognitive impairment in elderly linked to increased blood pressure variability

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Takeaway

  • Cognitive impairment in elderly is linked to increased blood pressure (BP) variability.

Study design

  • 353 community residents aged ≥65 y underwent ambulatory BP monitoring and Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG) at baseline and 5 y follow-up.
  • Funding: Study funded by Health Foundation, London, England, and others.

Key results

  • Independent of demographic and cardiovascular risk factors, greater daytime systolic BP variability was associated with worse baseline CAMCOG total and subscores, and daytime diastolic BP variability with worse total CAMCOG, CAMCOG executive score, and MMSE.
  • Daytime systolic BP variability independently predicted greater 5 y decline in total CAMCOG and MMSE (P<.05), even after adjustment for stroke history, use of cardioactive medication, and baseline MMSE/CAMCOG.
  • Mean BP was not associated with baseline cognitive function.

Limitations

  • Possible selection bias.
  • Difficulty in measuring BP variability.
  • Lack of brain imaging.

Why this matters

  • Cross-sectional studies have shown a link between BP variability and cognitive impairment in persons with hypertension and/or dementia, but evidence of this association in the general older population has been limited.
  • Reducing BP variability in older people may help prevent cognitive decline.
  • Small vessel cerebrovascular disease may mediate the association between BP variability and cognitive decline.
  • Future randomized trials should determine if antihypertensives known to control BP variability affect cognitive decline.