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Long‐Term Blood Pressure Variability and Risk of Cognitive Decline and Dementia Among Older Adults

Year: 2021
Type: article
Abstract: Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Methods and Results ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P =0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19–2.39) but not women (HR, 1.01; 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P =0.15; men: HR, 1.36; 95% CI, 1.16–1.59; women: HR, 1.14; 95% CI, 0.98–1.32). Conclusions High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01038583; isrctn.com . Identifier: ISRCTN83772183.
DOI: 10.1161/jaha.120.019613
Authors: Michael E. Ernst, Joanne Ryan, Enayet K. Chowdhury, Karen L. Margolis, Lawrence J. Beilin, Christopher M. Reid, Mark R. Nelson, Robyn L. Woods, Raj C. Shah, Suzanne G. Orchard, Rory Wolfe, Elsdon Storey, Andrew M. Tonkin, Amy Brodtmann, John J. McNeil, Anne M. Murray
Institutions: University of Iowa, Monash University, Curtin University, HealthPartners, The University of Western Australia, Royal Perth Hospital, University of Tasmania, Menzies Institute for Medical Research, Rush University Medical Center, Florey Institute of Neuroscience and Mental Health, Hennepin County Medical Center, Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,025
OpenAlex ID: W3173969036
FWCI: 6.281
Cites: 53
Cited by: 55
Related to: 10