Blood Pressure and Cognitive Function in Older Adults With Cardiovascular Disease

Gunstad, John; Keary, Therese A.; Spitznagel, Mary Beth; Poppas, Athena; Paul, Robert; Sweet, Lawrence H.; Hoth, Karin F.; Haley, Andreana P.; Forman, Daniel E.; Cohen, Ronald A.

doi:10.3109/00207450903139713

Cited by 17 publications

(24 citation statements)

References 34 publications

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“…Several investigators have demonstrated a U-shaped relationship [10–14] or a J-shaped association between cognitive function and blood pressure [4]. Most related researches use linear model including multivariate regression model [12,15], hierarchical linear model [14,16], mixed-effects regression analyses[11] to examine the possible relations. Few studies use splines to determine presence and type of the curvilinear relationships [17].…”

Section: Introductionmentioning

confidence: 99%

A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly

Zhu

Yin

et al. 2017

Journal of the American Medical Directors Association

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Objectives Higher or lower blood pressure may relate to cognitive impairment, while the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association. Design Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011 Setting Community-based setting in longevity areas in China Participants 7,144 Chinese elderly aged 65 years and older were included in the sample Measures Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP)-(DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE). Results Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP and MAP. The cut-points at which risk for cognitive impairment (MMSE<24) was minimized were determined by quadratic models as 141 mmHg, 85 mmHg, 62 mmHg and 103 mmHg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cut-points, each 1mmHg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cut-points, each 1mmHg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP and MAP, respectively. Conclusion A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention.

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Section: Introductionmentioning

confidence: 99%

A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly

Zhu

Yin

et al. 2017

Journal of the American Medical Directors Association

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“…This presents a unique opportunity to study the association between WMH burden caused by occupational factors rather than aging or illnesses in high-performing individuals with optimal health, free of the cardiovascular and metabolic risk factors frequently present in individuals with significant WMH burden. [12][13][14]16,17 We studied the effects of occupational hypobaria on neurocognition by testing 2 hypotheses: (1) there will be a significant reduction in the neurocognitive test scores between USAF pilots (AFPs) repetitively exposed to hypobaria compared with AFPs not exposed to repetitive hypobaria, and (2) the volume and number of WMH will explain a significant proportion of the variability of the neurocognitive performance in AFPs who were occupationally exposed to repetitive hypobaria.…”

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confidence: 99%

Lower neurocognitive function in U-2 pilots

et al. 2014

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“…For instance, higher blood pressure can lead to endothelial dysfunction 13 breakdown of the blood brain barrier, 25 and/or atherosclerosis in the large cerebral and cervicocerebral arteries 26 —all identified risk factors for brain atrophy. 27, 28 Indeed, past work suggests that higher arterial pressure may be uniquely associated with mortality risk in HF compared to cardiac function 29 and future work should determine whether such findings involve the effects of high blood pressure on the brain.…”

Section: Discussionmentioning

confidence: 99%

“…The association between resting blood pressure and cognitive function in cardiovascular disease populations is mixed with some studies even showing a positive relationship between these variables. 10, 28 Measured blood pressure is modified by the antihypertensive medication that almost all HF patients are currently prescribed. Thus, a diagnostic history of hypertension may be a better predictor of cognitive impairment as it may signify the sustained and cumulative pre-diagnostic effects of uncontrolled hypertension on the brain rather than readings from a single session.…”

Section: Discussionmentioning

confidence: 99%

Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure

Alosco

Brickman

Spitznagel

et al. 2013

Journal of the American Society of Hypertension

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Background Reduced systemic perfusion and comorbid medical conditions are key contributors to adverse brain changes in heart failure (HF). Hypertension, the most common co-occurring condition in HF, accelerates brain atrophy in aging populations. However, the independent and interactive effects of blood pressure and systemic perfusion on brain structure in HF have yet to be investigated. Methods Forty-eight older adults with HF underwent impedance cardiography to assess current systolic blood pressure status, and cardiac index to quantify systemic perfusion. All participants underwent brain magnetic resonance imaging to quantify total brain, total and subcortical gray matter volume, and white matter hyperintensities (WMH) volume. Results Regression analyses adjusting for medical and demographic factors showed decreased cardiac index was associated with smaller subcortical gray matter volume (p < .01) and higher systolic blood pressure predicted reduced total gray matter volume (p = .03). The combination of higher blood pressure and lower cardiac index exacerbated WMH (p = .048). Conclusions Higher blood pressure and systemic hypoperfusion are associated with smaller brain volume and these factors interact to exacerbate WMH in HF. Prospective studies are needed to clarify the effects of blood pressure on the brain in HF, including the role of long-term blood pressure fluctuations.

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Blood Pressure and Cognitive Function in Older Adults With Cardiovascular Disease

Abstract: Background-Past studies link elevated blood pressure (BP) and BP variability to adverse neurocognitive changes in community samples. However, little is known about the relationship between BP indices and cognitive function in older CVD patients.

Cited by 17 publications

References 34 publications

A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly

A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly

Lower neurocognitive function in U-2 pilots

Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure

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