Association of 24-Hour Ambulatory Blood Pressure Patterns with Cognitive Function and Physical Functioning in CKD

Abstract

Background and objectivesHypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysis-dependent CKD.Design, setting, participants, & measurementsAmbulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65–79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0–12) indicating better functioning; and (3) frailty, measured by meeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes.ResultsMean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB score was 9 (interquartile range, 7–10). At baseline, participants with masked hypertension had 0.41 (95% CI, −0.78 to −0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment.ConclusionsIn patients with CKD, dipping and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty.

Ambulatory BP Phenotypes and Their Association with Target Organ Damage and Clinical Outcomes in CKD

“…In this analysis of the CRIC study, dipping BP patterns were not associated with prevalent cognitive impairment assessed with the Modified Mini-Mental Status Examination (8). In longitudinal analysis, compared with normal dipping, extreme dipping was associated with a marginally greater incidence of cognitive impairment (hazard ratio, 1.83; 95% CI, 0.99 to 3.34) (8). Nondipping and reverse dipping had no association with incident cognitive dysfunction (8).…”

“…In the second study discussed in this editorial, a crosssectional and longitudinal analysis of ambulatory BP data from 1502 participants in the CRIC study, Ghazi et al (8) showed the lack of association of BP and dipping patterns with prevalent or incident frailty. Paradoxically, there was also no association of dipping status with physical activity assessed with the short physical performance battery (SPPB) score (8). It has to be noted, however, that such associations may exist and may be bidirectional.…”

“…In longitudinal analysis, compared with normal dipping, extreme dipping was associated with a marginally greater incidence of cognitive impairment (hazard ratio, 1.83; 95% CI, 0.99 to 3.34) (8). Nondipping and reverse dipping had no association with incident cognitive dysfunction (8). Once again, this lack of association should not be interpreted as absence of a direct cause and effect relationship between disrupted circadian BP patterns and cognitive impairment.…”

The influence of hypertension management on frailty prevention among older persons aged 65 and over: a systematic review

“…Table 3 provides an overview of the included articles. Five observational studies [27,[30][31][32][33] and two randomised control trials [28,34] assessed the association between hypertension treatment and frailty occurrence or progression. Results were different across studies.…”

Intensive blood pressure control on dementia in patients with chronic kidney disease: Potential reduction in disease burden

“…Effects of daily SBP variability on cognitive function have been evaluated in a study conducted with 1502 participants for whom 24hour ambulatory BP have been obtained from the Chronic Renal Insufficiency Cohort (CRIC) which is a prospective observational cohort investigating the factors involved in the progression of CKD [37,38]. No statistically significant association has been established between cognitive impairment and day or nighttime systolic or diastolic BP and BP dipping patterns.…”