Increased Blood Pressure Variability May Be Associated With Cognitive Decline in Hypertensive Elderly Subjects With No Dementia

Bellelli, Giuseppe; Pezzini, Alessandra; Bianchetti, Angelo; Trabucchi, Marco

doi:10.1001/archinte.162.4.483

Cited by 31 publications

(24 citation statements)

References 8 publications

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“…An association has been reported between cognitive decline and increased BP variability as assessed by standard deviation of 24-h BP readings. 22 These results lend support to our present finding that abnormalities in cognitive function are associated with a dysregulation in nocturnal BP profile.…”

Section: Discussionsupporting

confidence: 87%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

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Section: Discussionsupporting

confidence: 87%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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“…However, recent findings indicated that increased BP variability, assessed by 24-hour ambulatory monitoring, was associated with poorer performance on cognitive tests, including executive function, or with cognitive impairment in both hypertensive and normotensive older adults. 5,6 As noted previously, assessment of BP reactivity in laboratory settings has been shown to generalize to ambulatory measures obtained during daily life. 8 Thus, various indexes of autonomic dysregulation have been related to poorer cognitive performance in older individuals.…”

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confidence: 82%

“…4 Greater variability in BP on 24-hour ambulatory monitoring is an index of autonomic dysregulation and has recently been associated with poorer cognitive performance or cognitive impairment in samples of older adults. 5,6 Variability in BP is also elicited by mental stress, both in laboratory settings and in daily life. Previously, BP responses assessed during neuropsychological testing were unrelated to cognitive performance in young men.…”

mentioning

confidence: 99%

Stress-induced blood pressure reactivity and cognitive function

Waldstein¹,

Katzel²

2005

Neurology

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“…9 A cross-sectional association with short-term BPV has been found also for cognitive function, especially in elderly hypertensives with no history of cerebrovascular disease. 10 The relationship between cognitive function and home BP is less known. Self-measured BP is a better predictor of cardiovascular outcomes than office BP and might also have a stronger association with the incidence of cognitive dysfunction.…”

Section: See Related Article P 1333-1338mentioning

confidence: 99%

Day-by-Day Blood Pressure Variability

Palatini

2014

Hypertension

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Dementia represents an important public health issue in developed countries because of increasing longevity of the elderly population.1 Cerebral damage is mediated by changes in cerebral vasculature affecting both large and small vessels. 2 The microvascular disease results in chronic ischemic changes affecting the white matter, which in the long run can lead to cognitive alterations, which may progress to overt vascular dementia.2 It is thus important to identify and counterbalance the risk factors for cognitive decline at a population level. Although high midlife blood pressure (BP) is associated with an increased risk of late-life dementia, 3,4 the pathophysiology of the relationship between elevated BP and low cognition remains unclear. In particular, it is uncertain whether, to preserve cognition, it is better not only to lower the mean BP level but also to achieve a more stable BP. Both high and, especially in the elderly, low BP have been linked to cognitive decline and dementia. 5 Patients with hypertension may be especially vulnerable to swings of pressure including episodes of hypotension, because in elderly persons with chronic hypertension, the shift of cerebral autoregulation toward higher BP levels makes the brain more exposed to hypoperfusion.6 BP variability (BPV) increases with age, and recent studies have reported an association between long-term BPV and silent cerebral lesions, in particular white matter hyperintensities.7 Of note, the association of BPV with poorer outcome was found in subjects with higher as well as in those with lower BP levels.7 In a cohort of 6506 elderly individuals followed-up for 8 years, Alpérovitch et al 8 found that an increase of 1 SD in the coefficient of variation of BP measured on 3 visits was associated with a 10% increased risk of dementia.BP measured out of office predicts cardiovascular outcomes better than traditional BP measured by the doctor. In addition it allows for an easy and detailed assessment of BPV, which may have relevant implications for the clinical evaluation of patients with hypertension. Clinical studies have shown that short-term BPV evaluated from 24-hour ambulatory monitoring was associated with white matter hyperintensities and silent infarcts.9 A cross-sectional association with short-term BPV has been found also for cognitive function, especially in elderly hypertensives with no history of cerebrovascular disease. 10The relationship between cognitive function and home BP is less known. Self-measured BP is a better predictor of cardiovascular outcomes than office BP and might also have a stronger association with the incidence of cognitive dysfunction. Indeed, in this issue of Hypertension, Matsumoto et al 11 demonstrated that home BP level was significantly higher in people with cognitive decline than in those without cognitive decline. For each 1 SD increase in the home systolic BP level, there was a 48% increase in the adjusted risk of cognitive decline. At variance, no differences in conventional BP were observed according to cognit...

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Increased Blood Pressure Variability May Be Associated With Cognitive Decline in Hypertensive Elderly Subjects With No Dementia

Cited by 31 publications

References 8 publications

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Stress-induced blood pressure reactivity and cognitive function

Day-by-Day Blood Pressure Variability

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