High blood pressure in dementia: How low can we go?

Turana, Yuda; Tengkawan, Jeslyn; Chia, Yook Chin; Teo, Boon Wee; Shin, Jinho; Sogunuru, Guru Prasad; Soenarta, Arieska Ann; Minh, Huynh Van; Buranakitjaroen, Peera; Chen, Chen Huan; Nailes, Jennifer; Hoshide, Satoshi; Park, Sungha; Siddique, Saulat; Sison, Jorge; Sukonthasarn, Apichard; Tay, Jam Chin; Wang, Tzung‐Dau; Verma, Narsingh

doi:10.1111/jch.13752

Cited by 9 publications

(9 citation statements)

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“…The HOPE Asia Network has published a number of papers on important Asia‐specific topics in hypertension . This Asia‐specific issue of the Journal of Clinical Hypertension provides an important resource including original research and review articles on the management of hypertension from a variety of Asian viewpoints, including topics such as central BP, environmental factors, comorbidities such as diabetes, atrial fibrillation, heart failure, and dementia, recent Asian guidelines and so forth . This issue also includes reports from twelve countries/regions in Asia to help define and highlight the current status of hypertension, its management, and their initiatives.…”

Section: Resultsmentioning

confidence: 99%

“…The “perfect 24‐hour BP control” strategy taking Asian characteristics into account is essential for achievement of the “zero” cardiovascular event goal . Considerable work has already been done on the journey to achieving this goal . Practically, a staged approach to the 24‐hour management of hypertension should be considered, first targeting morning hypertension, then nocturnal hypertension, followed by daytime hypertension .…”

Section: Perspectivesmentioning

confidence: 99%

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The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

Kario

2020

J of Clinical Hypertension

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The impact of hypertension-related cardiovascular disease and target organ damage, and therefore the benefits of blood pressure (BP) control, is greater in Asian than in Western countries. Asia-specific features of hypertension and its effective management are important and active areas of research. The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016and is now a member of the World Hypertension League. The main goal of the HOPE Asia Network is to improve the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. Considerable work has already been done on the journey to achieving this goal. We have shown that BP control status in Asia differs between countries, and even between regions within the same country. Several expert panel consensus recommendations and clinical guidance papers are available to support the use of home and ambulatory BP monitoring in the region. In addition, the AsiaBP@Home study prospectively investigated home BP control status across 15 specialist centers using the same validated device and measurement schedule. We have also proposed the concept of systemic hemodynamic atherothrombotic syndrome (SHATS), a vicious cycle of BP variability and vascular disease on cardiovascular events and organ damage, and suggested a SHATS score for risk stratification for clinical practice. This special issue of the journal collates Asia-specific resources and data, contributing to advances in hypertension management and cardiovascular disease prevention in the region.

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Section: Resultsmentioning

confidence: 99%

Section: Perspectivesmentioning

confidence: 99%

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

Kario

2020

J of Clinical Hypertension

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“…Hypertension is considered a more important risk factor for mortality in dementia patients without AF compared to those with AF due to the different ways in which hypertension and AF impact cardiovascular health and contribute to death ( 31 , 32 ). Hypertension can increase the risk of mortality by damaging blood vessels and increasing the risk of cardiovascular events ( 33 ), such as AF, heart attack and stroke, which can lead to death. In addition, hypertension can also worsen the underlying dementia and contribute to functional decline and decreased quality of life.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation as a contributor to the mortality in patients with dementia: A nationwide cohort study

Chen

Lin

Hsieh

et al. 2023

Front. Cardiovasc. Med.

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BackgroundKnowledge of the risk of death in patients with dementia is essential for planning preventive strategies. This study aimed to evaluate the effect of atrial fibrillation (AF) on death risks and other factors associated with death in patients with dementia and AF.MethodsWe conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database. We identified subjects with dementia diagnosed for the first time and AF diagnosed concomitantly between 2013 and 2014. Subjects under the age of 18 years were excluded. Age, sex, and CHA2DS2-VASc scores were 1: 4 matched for AF patients (N = 1,679) and non-AF controls (N = 6,176) using the propensity score technique. The conditional Cox regression model and competing risk analysis were applied. The risk of mortality was tracked till 2019.ResultsAF history was associated with higher risks of all-cause death (hazard ratio [HR]: 1.208; 95% confidence interval [CI]: 1.142–1.277) and cardiovascular death (subdistribution HR: 1.210; 95% CI: 1.077–1.359) in dementia patients than patients without a diagnosis of AF. For patients with both dementia and AF, they had a higher risk of death due to higher age, diabetes mellitus, congestive heart failure, chronic kidney disease, and prior stroke. Anti-arrhythmic drugs and novel oral anticoagulants significantly reduced the risk of death in patients with AF and dementia.ConclusionThis study found that AF is a risk factor for mortality in patients with dementia and explored several risk factors for AF-related mortality. This study highlights the importance of controlling AF especially in patients with dementia.

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“…However, in later life, low blood pressure may induce cerebral hypoperfusion, and therefore, lead to a neurodegenerative process and accelerate the clinical manifestations of cognitive impairment [29]. In a recent review, the optimal target for lower systolic blood pressure value was found 120-130 mmHg, especially in nondiabetic hypertensive patients with significant risk factors for dementia [30].…”

Section: Discussionmentioning

confidence: 99%

Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR)

Balcı

Eşme

Sümer

et al. 2021

Blood Pressure Monitoring

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Objectives Masked hypertension, defined as nonelevated clinic blood pressure with elevated out of clinic blood pressure, has been associated with increased cardiovascular events, mortality and cognitive impairment. No evidence exists regarding the effect of treating masked hypertension. In this study, we followed-up the patients in the G-MASH-cog study for 1 year and aimed to examine the effect of the management of masked hypertension on cognitive functions. Methods The G-MASH-cog study participants were followed-up for 1 year. In masked hypertensive individuals, lifestyle modification and antihypertensive treatment (perindopril or amlodipine) were initiated for blood pressure control. Measurements of cognitive tests and ambulatory blood pressure monitoring at baseline and at 1-year follow-up were compared. Results A total of 61 patients (30 in masked hypertension group; 31 in normotensive group) were included. Mean age was 72.3 ± 5.1 and 59% of the participants were female. Compared with baseline ambulatory blood pressure measurement results, patients with masked hypertension had significantly lower ambulatory blood pressure measurement results after 1-year follow-up. The quick mild cognitive impairment test (Q-MCI-TR) score increased with antihypertensive treatment (Q-MCI score at baseline = 41(19–66.5), at 1 year = 45.5 (22–70), P = 0.005) in masked hypertensive patients. In the final model of the mixed-effects analysis, when adjusted for covariates, interaction effect of the masked hypertension treatment with time was only significant in influencing the changes in Q-MCI scores over time in patients aged between 65 and 74 years (P = 0.002). Conclusions Treatment of masked hypertension in older adults was associated with improvement in cognitive functions.

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High blood pressure in dementia: How low can we go?

Cited by 9 publications

References 50 publications

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

Atrial fibrillation as a contributor to the mortality in patients with dementia: A nationwide cohort study

Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR)

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