Both Low and High 24-Hour Diastolic Blood Pressure Are Associated With Worse Cognitive Performance in Type 2 Diabetes: The Maastricht Study

Abstract

OBJECTIVEHypertension and diabetes are both risk factors for cognitive decline, and individuals with both might have an especially high risk. We therefore examined linear and nonlinear (quadratic) associations of 24-h blood pressure (BP) with cognitive performance in participants with and without type 2 diabetes. We also tested the association of nocturnal dipping status with cognitive performance. RESEARCH DESIGN AND METHODSThis study was performed as part of the Maastricht Study, an ongoing populationbased cohort study. Cross-sectional associations of 24-h BP (n = 713, of whom 201 had type 2 diabetes) and nocturnal dipping status (n = 686, of whom 196 had type 2 diabetes) with performance on tests for global cognitive functioning, information processing speed, verbal memory (immediate and delayed word recall), and response inhibition were tested using linear regression analysis and adjusted for demographics, vascular risk factors, cardiovascular disease, depression, and lipidmodifying and antihypertensive medication use. RESULTSAfter full adjustment, we found quadratic (inverted U-shaped) associations of 24-h diastolic blood pressure (DBP) with information processing speed (b for quadratic term = 20.0267, P < 0.01) and memory (immediate word recall: b = 20.0180, P < 0.05; delayed word recall: b = 20.0076, P < 0.01) in participants with diabetes, but not in those without. No clear pattern was found for dipping status. CONCLUSIONSThis study shows that both low and high 24-h DBP are associated with poorer performance on tests of information processing speed and memory in individuals with type 2 diabetes.Type 2 diabetes is associated with cognitive decline and dementia (1,2), but the pathological mechanisms underlying these associations are not yet clear. Proposed mechanisms include the role of vascular risk factors, such as hypertension. Some studies have shown an association of hypertension with cognitive dysfunction and Alzheimer disease in individuals with diabetes (3,4). In addition, diabetes and hypertension seem to interact in their effect on cognitive decline (5) and dementia (6),

Management of Adults With Diabetes and Cognitive Problems

“…Both low blood pressure and very high blood pressure later in life are associated with cognitive risk (44). This U-shaped relationship between blood pressure and cognitive performance has been described in a recent study examining patients with diabetes (45). Low and high 24-hour diastolic blood pressures were associated with worse performance on tests of information processing speed and verbal memory in people with diabetes.…”

Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study

“…We collected data on glucose metabolism status, hemoglobin A 1c (Hb A 1c ), total cholesterol, HDL, LDL, triglycerides, waist circumference, office blood pressure, 24-h average ambulatory blood pressure, medication use, smoking behavior, alcohol consumption, educational level, questionnaire based prevalent CVD, resting 12-lead electrocardiogram (ECG), and self-reported physical activity as described previously (20,22 ). Please see the online Supplemental Methods for further details and definitions.…”

Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study

“…We assessed glucose metabolism status, eGFR, smoking behavior, total-to-HDL cholesterol ratio, triglyceride levels, lipid-modifying medication, office or 24 h average ambulatory systolic blood pressure, antihypertensive medication, waist-to-hip ratio, alcohol consumption and educational level as described previously 26, 35, 36 .…”