Blood Pressure Variability and Dementia: A State-of-the-Art Review

Ma, Yuan; Tully, Phillip J.; Hofman, Albert; Tzourio, Christophe

doi:10.1093/ajh/hpaa119

Cited by 50 publications

(93 citation statements)

References 98 publications

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“…In contrast, we found that elevated SBP was associated with a reduced risk of dementia in subjects without hypertension, heart disease, or cognitive impairment, compared with those having a normal SBP. This finding conflicted with the accumulated evidence that BP variation was positively associated with the risk of dementia regardless of the direction [ 8 – 11 ]. In a practical sense, SBP should not be elevated by intervention for the purpose to reduce the risk of dementia.…”

Section: Discussionmentioning

confidence: 62%

“…Blood pressure (BP) as one of the modifiable vascular factors was observed to be associated with dementia outcomes in various forms, such as mean measure [ 3 ], prehypertension [ 4 ], orthostatic hypotension [ 5 ], and pulse pressure (PP) [ 6 ]. Recently, accumulated evidence indicates that BP variability, which contributes to cerebrovascular damage as an independent factor of mean BP [ 7 ], is positively associated with the risk of dementia [ 2 , 8 – 11 ]. The possible mechanism may be that a higher BP variability is correlated with increased hyperintensity lesions of white matter on brain imaging [ 12 ], increased intima-media thickness of carotid artery [ 13 ], and accelerated progression of early carotid atherosclerosis [ 2 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Cheng

et al. 2021

Aging

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The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Cheng

et al. 2021

Aging

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“…Interestingly, the effect of elevated BP on cognitive decline appears to be mediated by both vascular pathology as well as neuritic plaques and neurofibrillary tangles, suggesting that managing BP can alleviate both vascular and neurodegenerative pathways [ 107 – 109 ]. Beyond elevated mean BP, fluctuations of BP over a period of hours, days and years have been increasingly found to influence brain health [ 110 , 111 ▪ , 112 ▪▪ ]. Emerging evidence suggests a link between BP variability, SVD progression and dementia risk [ 111 ▪ , 113 ].…”

Section: Management Of Vascular Cognitive Impairmentmentioning

confidence: 99%

“…Beyond elevated mean BP, fluctuations of BP over a period of hours, days and years have been increasingly found to influence brain health [ 110 , 111 ▪ , 112 ▪▪ ]. Emerging evidence suggests a link between BP variability, SVD progression and dementia risk [ 111 ▪ , 113 ]. More insights are needed to define this complex relationship between BP profile in ageing and cognitive impairment.…”

Section: Management Of Vascular Cognitive Impairmentmentioning

confidence: 99%

Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management

Zotin

Sveikata

Viswanathan

et al. 2021

Current Opinion in Neurology

101

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Purpose of review We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. We further address available management and therapeutic strategies. Recent findings Vascular and neurodegenerative pathologies often co-occur and share similar risk factors. The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. Aggressive blood pressure control and multidomain lifestyle interventions are associated with decreased risk of cognitive impairment, but disease-modifying treatments are still lacking. Recent research has led to a better understanding of mechanisms leading to SVD-related cognitive decline, such as blood-brain barrier dysfunction, reduced cerebrovascular reactivity and impaired perivascular clearance. Summary SVD is the leading cause of VCI and is associated with substantial morbidity. Tackling cardiovascular risk factors is currently the most effective approach to prevent cognitive decline in the elderly. Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. Designing and testing disease-modifying interventions for VCI remains a key priority in healthcare.

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“…pdf dementia (Schneider et al, 2007), there is growing interest to study BPV in the context of cognitive aging and AD risk. Recent work suggests that elevated BPV is associated with cerebrovascular disease (Ma, et al, 2020a) and predictive of cognitive impairment and dementia, including AD and vascular dementia (Ma et al, 2020b;Rouch et al, 2020;Yoo et al, 2020), even in healthy older adults with wellcontrolled average BP (Cho et al, 2018). Chronic large fluctuations in BP may stress arterial walls and promote microvascular injury and arterial remodeling (Nagai et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Blood pressure variability and medial temporal atrophy in apolipoprotein ϵ4 carriers

Sible

Nation

Initiative³

2021

Brain Imaging and Behavior

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Blood pressure variability is an emerging risk factor for dementia but relationships with markers of neurodegeneration and Alzheimer’s disease risk are understudied. We investigated blood pressure variability over one year and follow-up medial temporal brain volume change in apolipoprotein ϵ4 carriers and non-carriers, and in those with and without Alzheimer’s disease biomarker abnormality. 1051 Alzheimer’s Disease Neuroimaging Initiative participants without history of dementia or stroke underwent 3–4 blood pressure measurements over 12 months and ≥ 1 MRI thereafter. A subset (n = 252) underwent lumbar puncture to determine Alzheimer’s disease cerebral spinal fluid amyloid-beta and phosphorylated tau biomarker abnormality. Blood pressure variability over 12 months was calculated as variability independent of mean. Longitudinal hippocampal and entorhinal cortex volume data were extracted from serial brain MRI scans obtained after the final blood pressure measurement. Apolipoprotein ϵ4 carrier status was defined as at least one ϵ4 allele. Bayesian growth modelling revealed a significant interaction of blood pressure variability by ϵ4 by time on hippocampal (ß: -2.61 [95% credible interval -3.02, -2.12]) and entorhinal cortex (ß: -1.47 [95% credible interval -1.71, -1.17]) volume decline. A similar pattern emerged in subsets with Alzheimer’s disease pathophysiology (i.e., abnormal levels of both amyloid-beta and phosphorylated tau). Findings suggest that elevated blood pressure variability is related to medial temporal volume loss specifically in ϵ4 carriers, and in those with Alzheimer’s disease biomarker abnormality. Findings could implicate blood pressure variability in medial temporal neurodegeneration observed in older ϵ4 carriers and those with prodromal Alzheimer’s disease.

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Blood Pressure Variability and Dementia: A State-of-the-Art Review

Cited by 50 publications

References 98 publications

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management

Blood pressure variability and medial temporal atrophy in apolipoprotein ϵ4 carriers

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