Night blood pressure variability, brain atrophy, and cognitive decline

Abstract

BackgroundAlthough blood pressure variability (BPV) has emerged as a novel risk factor for Alzheimer's disease, few studies have examined the effects of night BPV on brain structure and function. This study investigated the association of night BPV with brain atrophy and cognitive function changes.MethodsThe analysis included 1,398 participants with valid ambulatory blood pressure (BP) monitoring at baseline and both baseline and 4-year follow-up brain magnetic resonance images who were recruited from the Korean Genome and Epidemiology Study. Participants underwent a comprehensive neuropsychological test battery. BPV was derived from ambulatory BP monitoring and calculated as a standard deviation (SD) of 24-h and daytime and nighttime BP.ResultsDuring the median follow-up of 4.3 years, increased SD of night systolic or diastolic BP was an indicator of total brain volume reduction, while daytime BPV or night average BP was not associated with total brain volume changes. High SD of night systolic BP was associated with reduced gray matter (GM) volume, independent of average night BP, and use of antihypertensive drugs. It also was associated with a reduction of temporal GM volume, mostly driven by atrophy in the left entorhinal cortex and the right fusiform gyrus. In cognitive performance, high variability of night systolic BP was associated with a decrease in visual delayed recall memory and verbal fluency for the category.ConclusionIncreased night BPV, rather than night mean BP, was associated with reduced brain volume and cognitive decline. High night BPV could be an independent predictor for rapid brain aging in a middle-aged population.

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

“…Additionally, daytime systolic BPV, but not nighttime BPV, was reduced in the intensive treatment group and was predictive of probable dementia in the standard treatment group. The present findings add information about clinical diagnosis to previous observational studies linking BPV via ambulatory monitoring to cognitive decline typically measured with single tests of cognition ( 1 , 23 – 27 ). Additionally, the current study used data from a cohort with rigorously controlled mean BP levels, which enabled us to assess the contribution of BPV vs mean BP to dementia risk at a level not typically available in observational cohorts.…”

“…This method has the added benefits of monitoring an individual’s BP in their everyday environment (vs clinic setting) and reducing the potential for white-coat hypertension or masked hypertension ( 7 , 22 ). Several observational studies of BPV via ambulatory monitoring suggest links with cognitive decline ( 1 , 23 – 27 ) but relationships with dementia risk remain understudied. Additionally, no prior studies have investigated whether BPV over 24 hours may relate to risk for dementia under specific antihypertensive strategies.…”

Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source

“…By analyzing all revealed significant risk factors of ESUS described above, it can be concluded that the vast majority of them could be the consequences of AH. For instance, it was demonstrated that AH is strongly associated with small vessel diseases that clinically manifest as brain changes (cerebral microbleeds, brain atrophy, and the others) and cognitive deterioration that were found in our research [29][30][31][32]. It is also well known that AH may be the leading cause (however, not the only one) of the increased heart rate [33,34], conduction disturbance, elevated PASP [35], and heart atrial and ventricular remodeling [36][37][38], all of which were identified in ESUS patients in the current study.…”

Gray matter volume mediates the association of long‐term blood pressure variability with cognitive function in an adult population

“…Yu et al found that the volume of the temporal GM decreased by 0.039 for each unit increase in SBPV. 34 Elevated SBPV may lead to cognitive decline by damaging neurons. Although no similar previous studies have been conducted, a rat model of high BPV induced by performing sinoaortic denervation found that elevated BPV leads to extensive damage and loss of cardiomyocytes through an inflammatory response and then to the replacement of damaged cardiomyocytes through repair fibrosis.…”

“…Yu et al. found that the volume of the temporal GM decreased by 0.039 for each unit increase in SBPV 34 . Elevated SBPV may lead to cognitive decline by damaging neurons.…”