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Long-term blood pressure variability and risk of cognitive decline and dementia among older adults

Citation

Ernst, ME and Ryan, J and Chowdhury, EK and Margolis, KL and Beilin, LJ and Reid, CM and Nelson, MR and Woods, RL and Shah, RC and Orchard, SG and Wolfe, R and Storey, E and Tonkin, AM and Brodtmann, A and McNeil, JJ and Murray, AM, Long-term blood pressure variability and risk of cognitive decline and dementia among older adults, Journal of the American Heart Association, 10, (13) pp. 1-11. ISSN 2047-9980 (2021) [Refereed Article]


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Copyright 2021 The Authors. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: doi:10.1161/JAHA.120.019613

Abstract

Background: Blood pressure variability (BPV) in midlife increases risk of late-life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long-term, visit-to-visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial.

Methods and Results: ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow-up visits. Time-to-event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P=0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19-2.39) but not women (HR, 1.01; 95% CI, 0.72-1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P=0.15; men: HR, 1.36; 95% CI, 1.16-1.59; women: HR, 1.14; 95% CI, 0.98-1.32).

Conclusions: High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, blood pressure variability, cognitive impairment, dementia
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Nelson, MR (Professor Mark Nelson)
ID Code:146921
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-10-04
Last Modified:2021-11-03
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