Abstract-Although an association between high blood pressure and cognitive decline has been reported, no studies have investigated the association between home blood pressure and cognitive decline. Home blood pressure measurements can also provide day-to-day blood pressure variability calculated as the within-participant SD. The objectives of this prospective study were to clarify whether home blood pressure has a stronger predictive power for cognitive decline than conventional blood pressure and to compare the predictive power of the averaged home blood pressure with day-to-day home blood pressure variability for cognitive decline. Of 485 participants (mean age, 63 years) who did not have cognitive decline (defined as Mini-Mental State Examination score, <24) initially, 46 developed cognitive decline after a median follow-up of 7.8 years. Each 1-SD increase in the home systolic blood pressure value showed a significant association with cognitive decline (odds ratio, 1.48; P=0.03). However, conventional systolic blood pressure was not significantly associated with cognitive decline (odds ratio, 1.24; P=0.2). The day-to-day variability in systolic blood pressure was significantly associated with cognitive decline after including home systolic blood pressure in the same model (odds ratio, 1.51; P=0.02), whereas the odds ratio of home systolic blood pressure remained positive, but it was not significant. Home blood pressure measurements can be useful for predicting future cognitive decline because they can provide information not only on blood pressure values but also on day-to-day blood pressure variability. provided. 7 Thus, it can be hypothesized that home BP can better predict future cognitive decline than conventional BP.One of the clinically significant aspects of home BP measurements is produced by the multiple BP measurements. 6 These multiple home BP measurements can also produce day-to-day BP variability that is calculated from the SD of home BP. Our previous studies demonstrated that high day-to-day BP variability was associated with an increased risk of cardiovascular mortality, independent of home BP values, and other risk factors. 8,9 However, no studies have investigated the associations of day-to-day BP variability with cognitive impairment.The objectives of this prospective study were to examine and to confirm the stronger predictive power of home BP values for cognitive decline than conventional BP and to compare the predictive power of the averaged home BP and the day-to-day home BP variability for cognitive decline. Methods DesignThis report was part of the Ohasama study, a community-based BP measurement project ongoing since 1987. Socioeconomic and demographic characteristics of this region and details of the study have been described previously. 5,6 Study PopulationOf the remaining 2400 eligible individuals, 1436 participated in the baseline examination, and 1396 gave informed consent for follow-up analyses. Of these, the total number of participants included in the present analyses was 48...

Our findings imply that CBP measurements alone are insufficient to distinguish individuals at high risk of carotid atherosclerosis from those at low risk. However, these individuals do have distinct HBP measurements, suggesting that HBP measurement could become a valuable tool for predicting carotid atherosclerosis.

Ambulatory BP levels and BP variability were closely associated with carotid artery alteration, suggesting that these parameters are independent risk factors or predictors of carotid artery alteration.

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