Reverse Dipping of Systolic Blood Pressure Is Associated With Increased Dementia Risk in Older Men

Abstract

A lower day-to-night systolic blood pressure (BP) dip has previously been associated with poor brain health and cognitive functions. Here, we sought to examine whether reduced (nighttime/daytime ratio of systolic BP >0.9 and ≤1) and reverse (nighttime/daytime ratio of systolic BP >1) dipping of systolic BP is associated with the prospective risk of being diagnosed with any dementia in Swedish older men. Twenty-four-hour ambulatory BP monitoring was used to estimate the nocturnal systolic BP dipping status of men at mean age 71 (n=997; 35% on antihypertensive medication) and 77.6 (n=611; 41% on antihypertensive medication). Dementia incidence during the observational period up to 24 years (n=286 cases) was determined by reviewing participants’ medical history and independently confirmed by at least 2 experienced geriatricians. Using time-updated Cox regression (ie, time-updated information on covariates and exposure), we found that reverse systolic BP dipping was associated with a higher risk of being diagnosed with any dementia (adjusted HR, 1.64 [95% CI, 1.14–2.34], P =0.007) and Alzheimer’s disease (1.67 [1.01–2.76], P =0.047) but not vascular dementia (1.29 [0.55–3.06], P =0.559). In contrast, reduced dipping of nocturnal systolic BP was not associated with a higher risk of being diagnosed with dementia. Our findings suggest that reverse systolic BP dipping may represent an independent risk factor for dementia and Alzheimer’s disease in older men. Future studies should decipher whether therapies lowering nocturnal systolic BP below daytime levels, such as bedtime dosing of antihypertensive medication, can meaningfully curb the development of dementia.

Sleep and circadian rhythms: pillars of health—a Keystone Symposia report

“…More specific, reverse dippers, that is, those who had higher blood pressure in the night compared with the day, had a 64% greater risk of dementia, in particular Alzheimer's disease. This effect was independent of hypertension or other common risk factors 104 . Tan noted that it may be worth investigating whether taking blood pressure medication in the evening, rather than earlier in the day, to lower nighttime blood pressure could lower the risk of dementia.…”

Research progress on the correlation between sacubitril-valsartan and cognitive function in hypertensive patients

“…Elevated intravascular pressure also does harm to cerebrospinal fluid drainage by the gliallymphatic system, bringing about impaired lymphatic clearance of Aβ [14]. Studies have found that nocturnal systolic blood pressure decreases brain Aβ and tau protein clearance through the gliallymphatic system, while nocturnal blood pressure increases brain lymphatic transport, which may be one of the mechanisms of AD in reverse dipper hypertension [20]. From the above, the pathophysiological characteristics of hypertensive patients are important mechanisms leading to the increased risk of AD.…”

Prognostic value of 24‐hour ambulatory blood pressure patterns in diabetes: A 21‐year longitudinal study

“…Moreover, “reverse dippers” (also called “risers” or “inverted dippers”), who have a mean nocturnal BP higher than diurnal BP (nighttime/daytime SBP ratio >1), have been assessed separately from nondippers in only a few studies 19,21‐23 . This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension‐mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes 23‐26 …”

“…19,[21][22][23] This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension-mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes. [23][24][25][26] The aim of the present study was to define the clinical features and long-term prognostic value for all-cause mortality of the different BP patterns, as measured through 24-hour ambulatory BP monitoring (ABPM), in patients with diabetes. To this end, we retrospectively analysed cross-sectional and 21-year longitudinal data from the "CHronic diabetes complications and All-cause Mortality in PIsa from 1999…”

“… 19 , 21 , 22 , 23 This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension‐mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes. 23 , 24 , 25 , 26 …”