Blood Pressure-Related Cognitive Decline

Abstract

Abstract-Systolic and diastolic blood pressures have been inversely related to cognitive performance in prospective and cross-sectional studies. However, in large, community-based samples, these findings have been limited to older adults. In this 20-year longitudinal study, we examined the relationship between baseline blood pressure and cognitive decline for 529 participants using 2 age groups (18 to 46 years and 47 to 83 years). Cognitive performance was measured over multiple examinations with the Wechsler Adult Intelligence Scale from which 4 scores were derived by factor analysis. A 2-stage growth curve method of analysis was used to model cognitive change. Results indicated that higher levels of baseline systolic blood pressure, diastolic blood pressure, mean arterial pressure, and blood pressure categories as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were significantly associated with decline in Visualization/Fluid abilities in both younger and older age groups. Young adults are as susceptible to blood pressure-related longitudinal decline in cognitive performance as are older adults. Key Words: blood pressure Ⅲ age Ⅲ arterial hypertension Ⅲ cognition Ⅲ prospective studies Ⅲ risk factors H ypertension is related to poorer cognitive performance in adults, 1,2 and hypertension-related changes in the brain are well-documented. 3-9 Systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels have been inversely related to cognitive performance level. 2,10,11 Moreover, DBP and SBP levels in midlife have been inversely associated with performance levels on cognitive tests administered at later ages. 9,[12][13][14] It is important to determine whether baseline BP values are associated with accelerated cognitive change with advancing age. Longitudinal designs are methodologically superior to cross-sectional designs because BP level can be related to intra-individual decline in cognitive functioning. 15,16 Most of the longitudinal studies using large, community-based samples have involved only midlife or older individuals. [17][18][19][20] Recently, Knopman et al studied persons ranging in age from 47 to 70 years and found that hypertension was related to cognitive decline from baseline to 6-year follow-up, but only for persons aged 58 to 70 years. 21 In contrast to longitudinal findings, cross-sectional studies indicate that younger adult hypertensive individuals may be more vulnerable to BP-related decrement in cognitive functioning than older hypertensive individuals. 10,22 This phenomenon may be an artifact of cross-sectional designs. 1,2,10 However, the possibility that younger adult hypertensive individuals exhibit greater cognitive decline than older hypertensive individuals has not been tested with a longitudinal design that included persons younger than 47 years of age. The major objective of the present study was to compare older and younger adults with respect to BP-associated cognitive decline using a prospective longit...

Long‐Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study

“…Higher midlife SBP levels have been consistently associated with lower cognitive function in later life 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Most studies have assessed cognitive function at a single time point,4, 5, 6, 7, 8, 9 and, thus, our results have extended our understanding of this relationship by taking cognitive decline into account.…”

“…Evidence supporting a link between midlife blood pressure (BP) levels and late‐life cognitive outcomes continues to accumulate 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. In addition to BP levels, BP variability may be associated with cognitive function 12, 13, 14, 15, 16, 17, 18.…”

Ausência de relação entre hipertensão arterial sistêmica e desempenho cognitivo em idosos de uma comunidade

“…Ao contrário de alguns relatos [5][6][7][8] , neste estudo não foi encontrada relação estatisticamente significativa entre hipertensão arterial e declínio cognitivo. Conforme o esperado, as análises demonstraram que os níveis mais baixos de desempenho cognitivo foram encontrados em indivíduos mais velhos e com menor escolaridade.…”

“…Alguns estudos longitudinais [5][6][7][8] encontraram relação significativa entre a hipertensão arterial sistêmica e o declínio cognitivo em idosos, por outro lado, outros estudos, também longitudinais, não encontraram essa relação 9,10 .…”

“…O estudo de Elias e associados 6 Por outro lado, o estudo de Posner et al 9 não encontrou relação direta entre hipertensão arterial e declínio cognitivo, entretanto, seus resultados demonstraram a associação entre hipertensão arterial e aumento do risco de demência vascular. Indivíduos hipertensos apresentaram risco de desenvolver demência vascular três vezes maior que os indivíduos normotensos.…”