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Clinical Summary

Systolic inter-arm BP difference linked to cognitive decline in older people

Takeaway

  • Systolic inter-arm difference (IAD) in blood pressure (BP) ≥5 mmHg was associated with cognitive decline in older people. 
Why this matters
  • An IAD is easily measured without additional equipment or skills.
  • Confirmation of IAD as a risk marker for future cognitive decline may help to inform personalised discussion of BP lowering and other preventive strategies in reducing the risk of cognitive decline.
Study design
  • This prospective study of older adults used data from the Invecchiare in Chianti (InCHIANTI) study (n=1133); median follow-up period: 9 years.
  • Association of IAD in BP with declines in 30-point mini mental state examination (MMSE), Trail Making Tests A and B, and with composite outcomes (decline in any of these scores) was evaluated.
  • Funding: None disclosed.
Key results
  • The rate of decline in MMSE scores was greater in participants with an IAD ≥5 mmHg and ≥10 mmHg.
  • On univariable analyses, continuous IAD was associated with the composite outcome (OR, 1.16 [95% CI, 1.02-1.31] per 5 mmHg of IAD).
  • A substantial decline in the MMSE score was noted with systolic IAD in BP ≥5 mmHg (OR, 1.41; 95% CI, 1.03-1.93; P=.032).
  • Systolic IAD in BP ≥5 mmHg (OR, 1.44; 95% CI, 1.10-1.89; P=.009) or ≥10 mmHg (OR, 1.39; 95% CI, 1.03-1.88; P=.030) correlated with substantial decline in the composite outcome.
  • After multivariable adjustment, only an IAD ≥5 mmHg remained associated with increased odds of decline in the composite outcome (OR, 1.46; 95% CI, 1.05-2.03; P=.026).
  • No significant association was observed between systolic IAD in BP and Trail Making Tests A and B.
Limitations
  • Possibility of measurement error.
  • Lack of power because of sample size limitations.

References


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