Midterm Blood Pressure Variability Is Associated with Poststroke Cognitive Impairment: A Prospective Cohort Study

Abstract

ObjectiveThe aim of this study was to investigate the relationship between blood pressure variability (BPV) and poststroke cognitive impairment (PSCI).MethodsSeven-hundred ninety-six patients with acute ischemic stroke were included in this study. Midterm BPV was evaluated by calculating the SD and coefficient of variation (CV, 100 × SD/mean) of systolic blood pressure (SBP) and diastolic blood pressure during the 7 days after stroke onset. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at admission and at all follow-up visits. Patients with MoCA scores <26 were considered to have PSCI.ResultsThe incidence of PSCI reached its peak (72%) 3 months after stroke onset and decreased to 30.3% at 12 months poststroke. After adjusting for covariables, the increase in the prevalence of PSCI at 3 months was independently associated with increases in the CV of blood pressure during the 7 days after stroke [odds ratios and 95% CI for patients in the second to fifth quintiles of SBP CV were 2.28 (1.18, 4.39), 2.33 (1.18, 4.62), 2.69 (1.31, 5.53), and 4.76 (1.95, 11.67), respectively]. Sub-analysis of the MoCA scores revealed that the patients had impairments in visuoperceptual abilities and executive functions, as well as in naming and delayed recall (p < 0.05).ConclusionMidterm BPV during the early phase of acute ischemic stroke is independently associated with PSCI, especially in the visuoperceptual, executive, and delayed recall domains.Clinical Trial Registration, identifier ChiCTR-TRC-14004804.

Blood pressure variability and cognitive dysfunction: A systematic review and meta‐analysis of longitudinal cohort studies

“…In short, 7 924 168 individuals over a follow‐up duration of 3 months to 22 years (mean age range, 54.3–84.4 years; 52.4% male) were included. Some studies required participants with specific comorbidities such as stroke or cardiovascular disease 23–28 . The remaining studies included the general population, and two studies by Haring (2019) 29 and Liu (2015) 30 excluded individuals with comorbidities, including diabetes mellitus, coronary heart disease, and/or stroke.…”

“…Some studies required participants with specific comorbidities such as stroke or cardiovascular disease. 23 , 24 , 25 , 26 , 27 , 28 The remaining studies included the general population, and two studies by Haring (2019) 29 and Liu (2015) 30 excluded individuals with comorbidities, including diabetes mellitus, coronary heart disease, and/or stroke. Among BPV measurement modalities, office BP was adopted in 15 (75%) studies, home BP in 4 (20%) studies, and ambulatory BP in 2 (10%) studies.…”

The correlation of blood pressure variability and cognitive function in hypertension patients: a meta-analysis

“…Based on the above results, it is believed that chronic ischemia caused by hypertension may cause the interruption of the day and night changes in blood pressure through the damage of the brain's self-regulatory function, and then the blood pressure does not drop during sleep 43 . Previous studies 44,45 have found that systolic blood pressure variability is more predictive of cognitive dysfunction than systolic blood pressure. It's been reported that through community experiments that higher blood pressure variability is related to the decline in cognitive function of patients assessed by simple mental status examination 46 .…”

Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

“…Consistent with our findings, the incidence of cognitive impairment was reported to be 37.3% in a study of 209 patients with mild ischemic stroke ( 23 ). However, another prospective study recruiting 796 Chinese patients with ischemic stroke demonstrated that the prevalence of PSCI reached its peak (72%) 3 months after the stroke onset and decreased to 30.3% at 12 months ( 21 ). These results suggested an urgent need for an internationally agreed definition of PSCI.…”

“…Also, severe white matter lesions are mainly correlated with frontal lobe dysfunction, which was recognized as the consequence of damaged neural transmission and interneural connection ( 25 ). Similarly, Geng et al analyzed the data of a Stroke Registry database and observed that patients with PSCI had severe stroke severity as compared with those without PSCI ( 21 ). Therefore, the relationship between SAA and cognitive impairment might be caused by above factors.…”