“Do it-yourself”: Home blood pressure as a predictor of traditional and everyday cognition in older adults

Abstract

BackgroundHypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored.MethodsWe examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed “everyday cognition” measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks.ResultsGood to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures.ConclusionOur findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Effects of Blood Pressure on Cognitive Performance: A Systematic Review

“…Some studies have reported J-shaped [49] or U-shaped [54,61] curvilinear relationships between blood pressure and mnestic performance. However, some studies did not confirm any relationship between blood pressure and memory [59,70,78,86,90].…”

“…When studies considered hypertensive patients, they found that this condition was associated with a lower executive performance [86][87][88]90]. However, the relationship between hypertension and executive functioning was not confirmed by all the studies [48,56,85].…”

“…Eleven studies [75,[80][81][82][83][85][86][87][88][89][90] made a comparison between hypertensive and normotensive individuals. According to the international guidelines [91,92].…”

“…Blood pressure negatively affects information processing speed. A higher general blood pressure [72,73,76,88,90] or an elevated systolic blood pressure [48,62,71] are associated with slower information processing. However, one study showed a positive relationship between low blood pressure and poor performance in processing speed [64].…”

The impact of cardiovascular risk factors on cognition in Hispanics and non-Hispanic whites

“…In general, Hispanics tend to have 2%-5% lower prevalence of hypertension across the lifespan compared to non-Hispanic whites (Sorlie et al 2014;Balfour et al 2016) but higher rates of obesity, with rates at 37% and 43% for Hispanic males and females, respectively (Daviglus et al 2012). Even among cognitively normal older adults, the presence of cardiovascular risk factors (e.g., hypertension and obesity) is associated with poorer cognitive performance (Raz et al 2003;Gunstad et al 2007;Crichton et al 2014;Bangen et al 2015;Yeung and Loken Thornton 2017) and increased risk of Alzheimer's and vascular dementia (Meng et al 2014; for reviews, see Tolppanen et al 2012;Pedditizi et al 2016). Although fewer studies have been carried out among Hispanic cohorts, the results suggest that the presence of cardiovascular risk factors has similar negative effects on cognition among older Hispanics, including increasing risk of dementia (Haan et al 2003; but see Rodríguez-Saldaña et al 2002).…”