Diurnal blood pressure loads are associated with lower cognitive performances in controlled-hypertensive elderly individuals

Colina, Adrián Noriega de la; Wu, Rong; Desjardins-Crépeau, Laurence; Badji, Atef; Lamarre-Cliché, Maxime; Doyon, Julien; Bherer, Louis; Girouard, Hélène

doi:10.1097/hjh.0000000000002155

Cited by 6 publications

(5 citation statements)

References 51 publications

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“…Optimization of blood pressure in patients with hypertension is expected to have a substantial public health impact owing to prevention of VCI and AD, even in the short term. Diurnal blood pressure loads are associated with lower cognitive performance in hypertensive adults aged 60–75 years, highlighting the importance of controlling blood pressure variability 177 . Combinations of pharmaceutical treatments and lifestyle interventions that lower blood pressure together with interventions that reduce blood pressure variability and prevent sudden surges in systolic pressure should be assessed in randomized clinical trials with clearly designed cognitive end points.…”

Section: Future Perspectivesmentioning

confidence: 99%

Hypertension-induced cognitive impairment: from pathophysiology to public health

et al. 2021

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Hypertension affects two-thirds of people aged >60 years and significantly increases the risk of both vascular cognitive impairment and Alzheimer’s disease. Hypertension compromises the structural and functional integrity of the cerebral microcirculation, promoting microvascular rarefaction, cerebromicrovascular endothelial dysfunction and neurovascular uncoupling, which impair cerebral blood supply. In addition, hypertension disrupts the blood–brain barrier, promoting neuroinflammation and exacerbation of amyloid pathologies. Ageing is characterized by multifaceted homeostatic dysfunction and impaired cellular stress resilience, which exacerbate the deleterious cerebromicrovascular effects of hypertension. Neuroradiological markers of hypertension-induced cerebral small vessel disease include white matter hyperintensities, lacunar infarcts and microhaemorrhages, all of which are associated with cognitive decline. Use of pharmaceutical and lifestyle interventions that reduce blood pressure, in combination with treatments that promote microvascular health, have the potential to prevent or delay the pathogenesis of vascular cognitive impairment and Alzheimer’s disease in patients with hypertension.

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Section: Future Perspectivesmentioning

confidence: 99%

Hypertension-induced cognitive impairment: from pathophysiology to public health

et al. 2021

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“…Nevertheless, previous studies have already associated morning hypertension with higher end-organ damage and loss of functional independence. 20,49,50 Our previous study 5 revealed worse scores on immediate and delayed recall as well as free recall tasks (all assessing episodic memory) in the treated elderly hypertensive group compared with their normotensive counterparts. We further observed that diurnal SBP loads (the percentage of diurnal SBP over 135 mm Hg) are associated with lower scores in cognitive flexibility and processing speed tasks in the treated hypertensive group.…”

Section: Discussionmentioning

confidence: 85%

“…41 Nevertheless, when we compare performances in cognitive tasks between well-controlled treated hypertensives and normotensives, there are still significant differences with hypertensive candidates performing worse. 5,42 These differences might be related to hypertension severity at the beginning of treatment, time of diagnosis, age of onset, length of antihypertensive treatment, and even type of antihypertensive medication. [43][44][45] Therefore, to better understand differences in cognitive performances between normotensives and treated hypertensive individuals, it is crucial to further comprehend the link between the different components of high BP and cognitive decline.…”

Section: Differences In Cognitive Task Performance Between Hypertensi...mentioning

confidence: 99%

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Associations Between Relative Morning Blood Pressure, Cerebral Blood Flow, and Memory in Older Adults Treated and Controlled for Hypertension

et al. 2021

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Hypertension, elevated morning blood pressure (BP) surges, and circadian BP variability constitute risk factors for cerebrovascular events. Nevertheless, while evidence indicates that hypertension is associated with cognitive dysfunctions, the link between BP variability and cognitive performance during aging is not clear. The purpose of this study is to determine the interaction between relative morning BP, cerebral blood flow (CBF) levels, and cognitive performance in hypertensive older adults with controlled BP under antihypertensive treatment. Eighty-four participants aged between 60 and 75 years old were separated into normotensive (n=51) and hypertensive (n=33) groups and underwent 24-hour ambulatory BP monitoring. They were also examined for CBF in the gray matter (CBF-GM) by magnetic resonance imaging and 5 cognitive domains: global cognition, working memory, episodic memory, processing speed, and executive functions. There was no difference in cognitive performance and CBF between normotensive and controlled hypertensive participants. Through a sensitivity analysis, we identified that, among relative morning BP variables, the best fit for CBF values in this cohort was the morning-evening difference in BP. The relative morning BP was negatively associated with CBF-GM in these hypertensive older adults only. In turn, CBF-GM levels were negatively associated with working and episodic memory scores in hypertensive older adults. This is the first extended study demonstrating an association between high relative morning BP and lower levels of CBF-GM, including the further impact of CBF-GM levels on the cognitive performance of specific domains in a community-based cohort of older adults with hypertension.

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“…Our study suggests that, in general, the cognitive performance of normotensive and hypertensive groups were similar in 70-year-olds which suggest that MRI markers of cerebral small vessel disease are able to identify white matter changes that do not yet translate into a decline in cognition. A recent study compared cognitive performance in controlled hypertensive and normotensive individuals aged 60–75 years, who were free from dementia ( Noriega de la Colina et al, 2019 ). In that study, controlled hypertensives participants had a lower performance in immediate and delayed recall and total number of words in the Rey Auditory Verbal Learning test compared to normotensives.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Biomarkers, Brain Structural and Cognitive Performances Between Normotensive and Hypertensive Controlled, Uncontrolled and Untreated 70-Year-Old Adults

Badji

Pereira

Shams

et al. 2022

Front. Aging Neurosci.

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Background: Hypertension is an important risk factor for Alzheimer’s disease (AD). The pathophysiological mechanisms underlying the relationship between AD and hypertension are not fully understood, but they most likely involve microvascular dysfunction and cerebrovascular pathology. Although previous studies have assessed the impact of hypertension on different markers of brain integrity, no study has yet provided a comprehensive comparison of cerebrospinal fluid (CSF) biomarkers and structural brain differences between normotensive and hypertensive groups in a single and large cohort of older adults in relationship to cognitive performances.Objective: The aim of the present work was to investigate the differences in cognitive performances, CSF biomarkers and magnetic resonance imaging (MRI) of brain structure between normotensive, controlled hypertensive, uncontrolled hypertensive, and untreated hypertensive older adults from the Gothenburg H70 Birth Cohort Studies.Methods: As an indicator of vascular brain pathology, we measured white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, enlarged perivascular space (epvs), and fractional anisotropy (FA). To assess markers of AD pathology/neurodegeneration, we measured hippocampal volume, temporal cortical thickness on MRI, and amyloid-β42, phosphorylated tau, and neurofilament light protein (NfL) in cerebrospinal fluid. Various neuropsychological tests were used to assess performances in memory, attention/processing speed, executive function, verbal fluency, and visuospatial abilities.Results: We found more white matter pathology in hypertensive compared to normotensive participants, with the highest vascular burden in uncontrolled participants (e.g., lower FA, more WMHs, and epvs). No significant difference was found in any MRI or CSF markers of AD pathology/neurodegeneration when comparing normotensive and hypertensive participants, nor among hypertensive groups. No significant difference was found in most cognitive functions between groups.Conclusion: Our results suggest that good blood pressure control may help prevent cerebrovascular pathology. In addition, hypertension may contribute to cognitive decline through its effect on cerebrovascular pathology rather than AD-related pathology. These findings suggest that hypertension is associated with MRI markers of vascular pathology in the absence of a significant decline in cognitive functions.

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Diurnal blood pressure loads are associated with lower cognitive performances in controlled-hypertensive elderly individuals

Cited by 6 publications

References 51 publications

Hypertension-induced cognitive impairment: from pathophysiology to public health

Hypertension-induced cognitive impairment: from pathophysiology to public health

Associations Between Relative Morning Blood Pressure, Cerebral Blood Flow, and Memory in Older Adults Treated and Controlled for Hypertension

Cerebrospinal Fluid Biomarkers, Brain Structural and Cognitive Performances Between Normotensive and Hypertensive Controlled, Uncontrolled and Untreated 70-Year-Old Adults

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