Systolic Blood Pressure Tracking Over 25 to 30 Years and Cognitive Performance in Older Adults

Abstract

Objective-To determine the extent to which individual changes in systolic blood pressure (SBP) over a 30-year interval are associated with differential neuropsychological outcomes in old age. Methods-Seven hundred seventeen survivors from the Western Collaborative Group Study, a longitudinal study of cardiovascular risk factors now in its 38th year of follow-up, with blood pressures measured in middle age (meanϭ45 years) and in old age (meanϭ75 years) and neuropsychological tests administered at follow-up were included in this analysis. Participants were grouped according to 30-year change in SBP (increased, decreased, or "normal"). Analyses focused on comparisons of neuropsychological performance of "high SBP trackers" (ie, those with persistent SBPՆ140 mm Hg throughout adult life) and of SBP "decreasers" with the performance of those whose SBP was either stable or changed in an expected way over time. Results-Only 7.5% of participants had elevated SBP in middle age, but 43.8% of participants had elevated SBP in old age. After adjustment for age, education, depression, clinically defined stroke, and use of antihypertensive medications and after exclusion of individuals with impaired cognitive performance at follow-up, high SBP trackers, 5.0% (nϭ36), performed consistently less well than the "normal" SBP subgroups on a composite measure of verbal learning and memory (Pϭ0.04). When compared with the "normal" SBP subgroup, the SBP decreasers, 5.3% (nϭ38), performed less well on speeded performance (Pϭ0.03). Conclusions-There is a relatively small group of people who maintain elevated SBP throughout their adult lives. These persons are at increased risk for reduced verbal learning and memory function. There is also a group of individuals who experience a decrease in SBP and who are at risk for decreased psychomotor speed. Delineation of these 2 SBP subgroups may lead to further clarification of the effects of SBP on neurobehavioral function in older adults. (Stroke. 1998;29:2334-2340.)Key Words: aging Ⅲ blood pressure Ⅲ cognition Ⅲ neuropsychology E levated systolic blood pressure (SBP) is associated with reduced levels of cognitive performance and increased cognitive decline in the majority of investigations of this issue. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In a reanalysis of data reported originally as not being supportive of the SBP-cognition association, 13,14 higher baseline SBP levels and increased chronicity of hypertension were found to be associated with lower cognitive performance measured 12 to 14 years later for measurements taken when few, if any, participants were on antihypertensive medication. [15][16][17] The long-term impact of elevated midlife SBP on reduced cognitive performance has been extended from the 14-year interval first reported by Elias et al [15][16][17] to 25 years 18 and to 30 years. 19 The primary implication of these findings is that SBP in middle age that is elevated but not necessarily hypertensive may exert a measurable deleterious effect on the function of the brai...

Differential age effects on cerebral blood flow and BOLD response to encoding: Associations with cognition and stroke risk

“…In the older participant group, consistent with several previous reports, we also found higher blood pressure to be associated with poorer performance on cognitive measures (e.g., Elias et al, 1993;Kilander et al, 1998;Knopman et al, 2001;Swan et al, 1998b;Tzourio et al, 1999) and smaller brain volumes (e.g., Akiyama et al, 1997;Swan et al, 1998a). Systolic blood pressure but not stroke risk showed a significant association with cognition.…”

“…Also, consistent with several previous reports, individuals with higher blood pressure demonstrated poorer performance on cognitive measures (Kilander et al, 1998;Knopman et al, 2001;Swan et al, 1998b;Tzourio et al, 1999). Specifically, there was a significant association between systolic blood pressure and memory (CVLT-II recognition memory accuracy: r = −.56, p = .05) measures.…”

Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain

“…31 Although based on relatively few subjects, the seminal report by Skoog et al 31 set the stage for subsequent studies published in the second half of the 1990s. [32][33][34][35] These multivariate-adjusted analyses confirmed that at a relatively high diastolic blood pressure (Ն75 mm Hg versus Յ70 mm Hg) at age 50, 32 a persistently elevated systolic blood pressure (Ն140 mm Hg) at ages ranging from 43 34 to 75 33 years, or stage 2 hypertension (Ն160 mm Hg systolic and Ն95 mm Hg diastolic) within the 59 to 71 age bracket 35 consistently predicted worse cognitive performance [32][33][34][35] or more severe white-matter lesions 34 at ages ranging from 63 35 to 79 34 years. To further clarify the role of blood pressure in the pathogenesis of cognitive impairment, we performed a systematic review of the prospective studies published since 2000 until early 2006, from which we extracted or computed summary statistics.…”

Blood Pressure-Related Cognitive Decline

“…2,10,11 Moreover, DBP and SBP levels in midlife have been inversely associated with performance levels on cognitive tests administered at later ages. 9,[12][13][14] It is important to determine whether baseline BP values are associated with accelerated cognitive change with advancing age. Longitudinal designs are methodologically superior to cross-sectional designs because BP level can be related to intra-individual decline in cognitive functioning.…”