Pulse Pressure, Cognition, and White Matter Lesions: A Mediation Analysis

Zang, Jiabin; Shi, Jianzhong; Liang, Jieying; Zhang, Xiaocong; Wei, Wenbin; Yao, Chun Hsu; Zhuang, Xiaodong; Wu, Guifu

doi:10.3389/fcvm.2021.654522

Cited by 10 publications

(9 citation statements)

References 31 publications

(38 reference statements)

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“…The subjects, who participated in our study, were individuals with an average age of 60 years; therefore, in this study, the impact of PP on cognitive performance of middle-aged populations wasfocused. Recently, consistent with our study, Zang et al [ 6 ] in a study on 3009 subjects from the SPRINT-MIND revealed that higher PP was associated with poor cognitive performance. Similarly, Obisesan et al [ 7 ], in a total of 3129 subjects from the Third National Health and Nutrition Examination Survey revealed that higher PP was associated with worse MMSE performance.…”

Section: Discussionsupporting

confidence: 92%

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Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

et al. 2022

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Background Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis. Methods We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe’s test, Kohs’ test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted. Results From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs’ scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure. Conclusion High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.

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Section: Discussionsupporting

confidence: 92%

“…However, there is conflicting evidence about the association of cognitive performance with PP. Several studies have suggested that high PP is associated with worse cognitive performance [ 6 – 9 ]. However, opposite results have also been demonstrated in some studies [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

et al. 2022

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“…The observed reduction in restricted diffusion in temporal regions and association fibers mediated effects of chronically elevated PP on worse executive function. These findings extend evidence from the SPRINT‐MIND Study, which reported that white matter lesion volume contributed to 9.5% of executive function impairment associated with PP 20 to suggest that even subtle microstructural injury related to elevated PP has clinically significant effects on cognitive aging. The mediating regions identified here include long‐range association fibers (ILF, IFO, and PHC) supporting the integration of sensory and cognitive information, as well as the amygdala, which modulates efficiency of the executive control network 45 .…”

Section: Discussionsupporting

confidence: 82%

“…The cognitive domains that appear to be affected by arterial stiffness include attention, 20 memory, 6,20 language, 21 and executive function 20 . Consistent with this literature, in the Rancho Bernardo Study (RBS) a 10 mmHg increase in PP was associated with a 9% increase in the odds of low performance on the Halstead‐Reitan Trail Making Test Part B (Trails B), a test of visuomotor tracking and executive function, 22 among participants younger than 80 years 23 .…”

Section: Introductionmentioning

confidence: 99%

Pulse pressure trajectories predict brain microstructure in community‐dwelling older adults: Associations with executive function and modification by APOE

Parada

Bergstrom

Bangen

et al. 2022

Alzheimer's & Dementia

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Introduction:Effects of chronic arterial stiffness on brain aging remain unclear. We, therefore, examined whether long-term trajectories of pulse pressure (PP) predicted brain microstructure, microstructure mediated PP-executive function associations, and APOE genotype modified PP-microstructure associations. Methods:We examined associations of PP trajectories with brain microstructure measured using restriction spectrum imaging in 146 community-dwelling older adults, whether microstructure mediated PP trajectory-executive function associations, and whether PP-restriction spectrum imaging correlations were modified by APOE-ε4 status.Results: Participants with trajectories of high PP had lower restricted isotropic diffusion (RI) compared to those with low PP trajectories and PP-executive function associations were mediated by subcortical and white matter RI. High PP more strongly correlated with lower RI and higher hindered diffusion among APOE-ε4 carriers than non-carriers.Discussion: Prolonged elevated PP predicts microstructural abnormalities which may contribute to impaired executive function. APOE-ε4 carriers may be most vulnerable to the adverse effects of PP on brain microstructure.

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“…[42][43][44] We observed incremental incidences of dementia and MCI with the increase of PP, which was in keeping with previous studies. 25,[45][46][47] However, intensive BP lowering therapy would not increase PP (Figure 1D). We did not find heterogeneity across baseline PP quartiles as to the effect of intensive SBP control on dementia or MCI.…”

Section: Discussionmentioning

confidence: 98%

Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial

Jiang

Wang

et al. 2023

Hypertension

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Background: The potential benefits or harms of intensive systolic blood pressure (BP) control on cognitive function and cerebral blood flow in individuals with low diastolic blood pressure (DBP) remain unclear. Methods: We conducted a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) that randomly assigned hypertensive participants to an intensive (<120 mm Hg; n=4278) or standard (<140 mm Hg; n=4385) systolic blood pressure target. We evaluated the effects of BP intervention on cognitive outcomes and cerebral blood flow across baseline DBP quartiles. Results: Participants in the intensive group had a lower incidence rate of probable dementia or mild cognitive impairment than those in the standard group, regardless of DBP quartiles. The hazard ratio of intensive versus standard target for probable dementia or mild cognitive impairment was 0.91 (95% CI, 0.73–1.12) in the lowest DBP quartile and 0.70 (95% CI, 0.48–1.02) in the highest DBP quartile, respectively, with an interaction P value of 0.24. Similar results were found for probable dementia (interaction P =0.06) and mild cognitive impairment (interaction P =0.80). The effect of intensive treatment on cerebral blood flow was not modified by baseline DBP either (interaction P =0.25). Even among participants within the lowest DBP quartile, intensive versus standard BP treatment resulted in an increasing trend of annualized change in cerebral blood flow (+0.26 [95% CI, −0.72 to 1.24] mL/[100 g·min]). Conclusions: Intensive BP control did not appear to have a detrimental effect on cognitive outcomes and cerebral perfusion in patients with low baseline DBP. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062

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Pulse Pressure, Cognition, and White Matter Lesions: A Mediation Analysis

Cited by 10 publications

References 31 publications

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

Pulse pressure trajectories predict brain microstructure in community‐dwelling older adults: Associations with executive function and modification by APOE

Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial

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