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Association of Blood Pressure With Cognitive Decline, Dementia, and Mortality
Quick Takes
- Long-term cumulative BP was associated with subsequent cognitive decline, risk for incident dementia, and all-cause mortality among cognitively healthy adults ≥50 years of age. This association was independent of other vascular risk factors and consistent in the two population-based cohorts.
- For both cumulative sBP and pulse pressure, elevated long-term exposure was associated with accelerated cognitive decline and a higher risk for incident dementia and all-cause mortality. Further, pulse pressure had additive value to sBP in predicting cognitive deficits and mortality.
- Conversely, for cumulative dBP, elevated long-term exposure was associated with decelerated cognitive decline and a lower risk for incident dementia and all-cause mortality.
Study Questions:
Is long-term cumulative blood pressure (BP) exposure associated with subsequent cognitive decline, incident dementia, and all-cause mortality among cognitively healthy adults?
Methods:
The study was performed using the HRS (Health and Retirement Study) and ELSA (English Longitudinal Study of Ageing) datasets. Participants were cognitively healthy men and women ≥50 years of age living in the United States and United Kingdom. BP was measured using the same technique and machine for systolic BP (sBP), diastolic BP (dBP), and pulse pressure. Cumulative BP was calculated as the area under the curve using measurements from wave 0 (1998-1999) to wave 4 (2008-2009) in ELSA (total three visits), and wave 8 (2006-2007) to wave 10 (2010-2011) in the HRS (total two visits). Outcomes included cognitive decline, incident dementia, and all-cause mortality. Covariates included age, sex, ethnicity as white or nonwhite, cardiovascular risk factors, and history of any heart disease, cancer and chronic lung disease, current smoking, alcohol at least once per week, physical activity <1 time/week, depressive symptoms, education, and use of antihypertensive medication.
Results:
A total of 7,566 and 9,294 participants from ELSA and the HRS were included (44.8% and 40.2% men and median age 62.0 years and 65.0 years, respectively). Median follow-up duration was 8.0 years for each cohort. Elevated cumulative sBP and pulse pressure were independently associated with accelerated cognitive decline (p < 0.001 for both), elevated dementia risk (p < 0.001 for both), and all-cause mortality (p < 0.001 for both), while a significant inverse association was observed for diastolic BP. Strong dose-response relationships were identified, with similar results for the two cohorts.
Conclusions:
Long-term cumulative BP was associated with subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged ≥50 years. Efforts are required to control long-term systolic BP and pulse pressure and to maintain adequate diastolic BP.
Perspective:
Studies in younger adults have demonstrated that long-term exposure to sBP is associated with worsening cognitive function in middle adulthood with no influence of dBP, likely because widened pulse pressure is not common in younger persons. As in this study, the findings in the SPRINT trial were that lower dBP was associated with higher rates of primary composite endpoints and all-cause mortality.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise, Hypertension, Smoking, Sleep Apnea
Keywords: Alcohol Drinking, Antihypertensive Agents, Blood Pressure, Cognition, Dementia, Hypertension, Depression, Exercise, Heart Disease Risk Factors, Lung Diseases, Middle Aged, Neoplasms, Primary Prevention, Retirement, Risk Factors, Smoking
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