Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies

Abstract

High blood pressure (BP) is considered as an important risk factor for cognitive impairment and dementia. BP variability (BPV) may contribute to cognitive function decline or even dementia regardless of BP level. This study aims to investigate whether BPV is an independent predictor for cognitive impairment or dementia. Literature searches were performed in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science to May 2021. Longitudinal studies that assessed the risk of dementia or cognitive impairment with BPV as the predictor was included. Meta-analysis and meta-regression were performed to evaluate the effect of BPV on the risk of dementia or cognitive impairment. A total of 5919 papers were identified, and 16 longitudinal studies were included, which had >7 million participants and a median age from 50.9 to 79.9 years and a median follow-up of around 4 years. Thirteen studies reported visit-to-visit BPV and concluded that systolic BPV increases the risk of dementia with a pooled hazard ratio of 1.11 (95% CI, 1.05–1.17), and increases the risk of cognitive impairment with a pooled hazard ratio of 1.10 (95% CI, 1.06–1.15). Visit-to-visit diastolic BPV also increased the risk of dementia and cognitive decline. A meta-regression revealed a linear relationship between higher BPV and risks of dementia and cognitive impairment. Similar findings were observed in the studies with day-to-day BPV. This study suggests that long-term BPV is an independent risk factor for cognitive impairment or dementia, so an intervention plan for reducing BPV can be a target for early prevention of dementia.

Visit-to-Visit Blood Pressure Variability and CSF Alzheimer Disease Biomarkers in Cognitively Unimpaired and Mildly Impaired Older Adults

“…The current investigation adds to ongoing work detailing relationships between BPV and AD. 6 , 10 , 11 , 13 , 16 - 18 , 38 In addition, patterns of CSF change were observed predominantly in APOE ε4 carriers, consistent with recent work relating BPV and APOE ε4 to other important markers of AD (e.g., medial temporal volume loss). 18 …”

High visit‐to‐visit blood pressure variability predicts global cognitive decline: The Multi‐Ethnic Study of Atherosclerosis

“…These results align with similar studies, which have observed relationships between high BPV and cognition. 10 , 12 , 14 , 22 , 41 , 42 , 43 This relationship may be driven by long‐term hemodynamic instability and associated microvascular damage, atherosclerosis, and organ hypoperfusion, leading to increased white matter lesions, cortical infarcts, and other neuropathological contributions to cognitive dysfunction. 44 Confidence in these results is strengthened by the consistency of this pattern across ARV and VIM, with VIM indicating an association independent of BP level.…”

“…7 , 45 However, the current study demonstrates cognitive decline over time, a key criterion for AD 46 in a sample with multiple ethnic groups, an important knowledge gap in this relationship. 43 The lack of association between BPV with other cognitive measures is notable. It has been suggested that this association may be attenuated in healthier populations.…”

Autonomic function predicts cognitive decline in mild cognitive impairment: Evidence from power spectral analysis of heart rate variability in a longitudinal study

“…Thus, the CAN represents the neuroanatomical correlate of the brain-heart axis ( Silvani et al, 2016 ). Also, autonomic dysfunction can lead to blood pressure (BP) dysregulation ( Julius and Weder, 1989 ) which can contribute to cognitive impairment via cerebral hypoperfusion ( Forte et al, 2019b ; Jia et al, 2021 ).…”