Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension

Nagai, Michiaki; Hoshide, Satoshi; Ishikawa, Joji; Shimada, Kazuyuki; Kario, Kazuomi

doi:10.1097/hjh.0b013e3283018333

Cited by 137 publications

(104 citation statements)

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“…Among studies to date, van Boxtel et al 23 reported lower levels of cognitive function in non-dippers than in dippers, but did not separately analyze the effects of extreme dipping. Furthermore, Nagai et al 24 reported a positive association between the percent changes in nocturnal BP (as a numeric variable) and MMSE score in untreated hypertensive subjects, but again did not separately analyze the effects of an extreme decrease in BP. In this study, changes in nocturnal BP itself did not differ between MCI subjects and normal controls (Table 2) due to the high prevalence of MCI among not only non-dippers and risers but also extreme dippers (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…These authors also found that reduced total brain matter was involved in the association between blunted nocturnal BP changes and lower MMSE score. 24 Furthermore, in a recent longitudinal analysis found that increased white matter hyperintensities could be a predictor of progression from normal to MCI. 31 Association of silent cerebral infarctions with the development of MCI was also reported in another community-based longitudinal study.…”

Section: Discussionmentioning

confidence: 99%

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Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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“…Several reports indicated that morning BP surge and morning hypertension increase the risk of organ damage and other conditions such as cardiovascular events, left ventricular hypertrophy, carotid intima-media thickness, and asymptomatic cerebral infarction, independent of 24-hour BP. 21,24,25 Increased nighttime BP is also associated with a higher cerebrovascular and cardiovascular event risk [26][27][28] and decreased cognitive and physical functions, 29,30 and vascular tissue damage has been shown to progress even if only nighttime BP is high, increasing the risk of cardiovascular events. 31 The importance of managing morning BP and nighttime BP is therefore well recognized.…”

Section: Discussionmentioning

confidence: 99%

Dose Timing of an Angiotensin II Receptor Blocker/Calcium Channel Blocker Combination in Hypertensive Patients With Paroxysmal Atrial Fibrillation

Kario

Uchiyama²,

Yoshida³

et al. 2016

J of Clinical Hypertension

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It has long been thought that there is a close association between hypertension and atrial fibrillation (AF). However, the efficacy of an angiotensin II receptor blocker for the prevention of organ damage in hypertensive individuals with AF is still controversial. The present study was a multicentered, prospective, randomized, open-label clinical trial investigating the differences in the effect of treatment with telmisartan/amlodipine combination tablets on blood pressure (BP) levels and BP variability between morning and bedtime administration in hypertensive patients with paroxysmal AF, using ambulatory BP monitoring (ABPM) and home BP. With this treatment, the patients' 24-hour BP, nighttime BP, preawake BP, and morning BP shown by ABPM were significantly reduced, and the antihypertensive effects were similar regardless of the timing of the drug administration. The standard deviation of day-by-day home systolic BP and the maximum home systolic BP were also significantly reduced, and these effects were similar regardless of the treatment timing. The N-terminal pro-brain natriuretic peptide level was significantly decreased only in the bedtime administration group. A larger study will demonstrate whether the bedtime administration of telmisartan/amlodipine combination tablets maximizes the risklowering effect against AF recurrence in paroxysmal AF hypertensive patients. J Clin Hypertens (Greenwich). 2016;18:1036-1044. ª 2016 Wiley Periodicals, Inc.A close association between hypertension and atrial fibrillation (AF) has long been suspected. The Framingham Heart Study 1 showed that hypertension was an independent risk factor for incident AF in a general population, and uncontrolled elevated blood pressure (BP) was associated with an increased risk of incident AF in patients treated for hypertension.2 Based on overseas clinical trials, the main etiology of AF is hypertension in approximately 60% of AF patients.3 In addition, the Suita Study, 4 a cohort study in Japan, showed that hypertension was associated with an increased risk of incident AF.It is also suspected that hypertension not only facilitates the onset and persistence of AF, but also raises the risk of a thromboembolism. Antihypertensive treatment is therefore considered essential for hypertensive individuals with AF to prevent recurrent AF, cerebral infarction, or heart failure. 5 In several countries, angiotensin II receptor blockers (ARBs) have attracted attention as a therapeutic drug for hypertensive individuals with AF.6-9 However, the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE I) 10 comparing the effect of irbesartan on patients with AF (mainly persistent and permanent types) with that of placebo showed no differences between irbesartan and placebo for the recurrence of AF, indicating that ARBs did not suppress the recurrence of AF. Valsartan also did not reduce the recurrent AF rate in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation (GISSI-AF...

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“…[2][3][4] Many prospective and cross-sectional observational studies have shown that hypertension is associated with cognitive decline in older persons. [5][6][7][8][9][10][11][12][13][14] Common to each of these studies, however, has been the relatively young age of the participants. The average age of these populations has been under 85 years; only a few studies have included individuals aged 90 years or above, and no studies have focused only on individuals aged 90 years or older.…”

Section: Introductionmentioning

confidence: 99%

Cognitive impairment and hypertension among Chinese nonagenarians and centenarians

et al. 2009

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In this study, we explore the association between hypertension and cognitive impairment in the very elderly, using a sample ranging in age from 90 to 108 years. This work was conducted as a cross-sectional study. Our population included 782 unrelated Chinese nonagenarians and centenarians (67.5% women, mean age 93.62 years). The mean cognitive function score for the sample was 14. 95 (s.d.: 5.99, range: 0-28). There were no significant differences between individuals with and without hypertension with regard to cognitive function scores (14.95±6.01 vs. 14.95±5.82, P¼0.997) or cognitive impairment prevalence (59.52 vs. 59.42, P¼0.976). There were also no significant differences in the prevalence of hypertension (56.99 vs. 57.10, P¼0.976) or in the levels of arterial blood pressure (including systolic blood pressure (SBP) and diastolic blood pressure (DBP) Keywords: Chinese; cognitive impairment; hypertensive; nonagenarians and centenarians INTRODUCTION About 10% of people older than 65 years have cognitive impairment, ranging from mild deficits to dementia. 1 Hypertension has been viewed as a common risk factor for cognitive disorders. 2-4 Many prospective and cross-sectional observational studies have shown that hypertension is associated with cognitive decline in older persons. [5][6][7][8][9][10][11][12][13][14] Common to each of these studies, however, has been the relatively young age of the participants. The average age of these populations has been under 85 years; only a few studies have included individuals aged 90 years or above, and no studies have focused only on individuals aged 90 years or older. Cognitive impairment and hypertension are both major components of age-related deterioration. 15,16 As the population of older persons increases, the number of cognitively impaired older individuals is expected to rise. 17,18 To the best of our knowledge, no studies have explored whether cognitive impairment is associated with hypertension among very old people, that is, those aged 90 years and above. In this study, we sought to observe the association of cognitive impairment with hypertension among very old people using a cohort of Chinese men and women aged 90-108 years.

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Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension

Abstract: In elderly hypertensive patients, absolute ambulatory systolic blood pressure level (particularly during sleep) and nocturnal dipping in systolic blood pressure were strong indicators of brain matter volume and cognitive function.

Cited by 137 publications

References 32 publications

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Dose Timing of an Angiotensin II Receptor Blocker/Calcium Channel Blocker Combination in Hypertensive Patients With Paroxysmal Atrial Fibrillation

Cognitive impairment and hypertension among Chinese nonagenarians and centenarians

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