Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

Abstract

BackgroundSystolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiovascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline.AimTo examine associations of IAD with cognitive decline in a community population.Design and settingA prospective study of older Italian adults enrolled in the InCHIANTI study.MethodUnivariable and multivariable associations of IAD were explored with declines in mini mental state examination (MMSE) scores, Trail Making Test A and B scores, and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline.ResultsThe rate of decline for MMSE scores in 1133 participants was greater with IAD ≥5 mmHg or ≥10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD, 95% confidence interval [CI] = 1.02 to 1.31). Substantial decline in MMSE score was seen with IAD ≥5 mmHg (OR 1.41, 95% CI = 1.03 to 1.93), and in the composite outcome with IAD ≥5 mmHg (OR 1.44, 95% CI = 1.10 to 1.89) or ≥10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multivariable adjustment, an IAD ≥ 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03).ConclusionAn IAD ≥5 mmHg is associated with cognitive decline in a representative older population. Given that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.

Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality

“…Additional data were identified through author contacts. 77 , 81 , 82 , 88 , 89 In total, we combined data from 24 of 34 confirmed eligible studies, representing two-thirds of potentially eligible participants, and comparison with the one published eligible IAD study that we did not obtain showed no evidence of inclusion bias. These IPD meta-analyses have required considerable data cleaning and preparation; closure of data inclusion in 2017 means that we could have excluded relevant recent publications, however, continued search updates to April 2020 have only identified one new potentially eligible study.…”

Association between inter-arm blood pressure difference and cardiovascular disease: result from baseline Fasa Adults Cohort Study

“…The prevalence of inter-arm blood pressure difference varies in different populations and this difference tends to increase in the presence of high blood pressure 8 . The inter-arm blood pressure difference is reported in 7% of diabetic patients, and 11% in high blood pressure patients 9 . In a study conducted by Essa et al, inter-arm systolic blood pressure difference greater than 10 mmHg was observed in 26.1% of study participants 3 .…”