Higher Blood Pressure Associated With Higher Cognition and Functionality Among Centenarians in Australia

Richmond, Robyn; Law, Jenaleen; Kay‐Lambkin, Frances

doi:10.1038/ajh.2010.236

Cited by 54 publications

(48 citation statements)

References 24 publications

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“…In support of this hypothesis, individuals with lower cerebral blood flow have been found to have higher rates of cognitive decline [27] and prevalent dementia [28]. If increased BP is a compensatory mechanism, it would also help maintain adequate perfusion in other vital organs [29] and may explain the protective associations between increased BP and other outcomes such as mortality [30], frailty indicators [31], disability [32], and physical decline [33] in the very elderly.…”

Section: Discussionmentioning

confidence: 66%

P2‐083: Age of Onset of Hypertension and Risk of Dementia in the Oldest‐old: The 90+ Study

Corrada

Hayden

Bullain

et al. 2014

Alzheimer's & Dementia

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Section: Discussionmentioning

confidence: 66%

P2‐083: Age of Onset of Hypertension and Risk of Dementia in the Oldest‐old: The 90+ Study

Corrada

Hayden

Bullain

et al. 2014

Alzheimer's & Dementia

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“…Cross-sectional studies in older individuals have demonstrated a relation between high BP and poor physical function and physical disability as defined by lower gait speed, difficulty with activities of daily living, or reduced lower limb function. [61][62][63] Results of longitudinal studies later in life are, however, inconsistent; in well-functioning older persons aged 70 to 80 years, high BP was related to physical decline (gait slowing) 61,64 and disability, 65 whereas in the oldest old low BP was related to physical decline 56,66 and lower grip strength. 67 Combined with systematic reviews from a life-course perspective reporting on the relation between BP and functioning, 51,68 these findings suggest an age-dependent association of BP with risk of functional impairment: midlife hypertension causes cognitive and physical limitations later in life, but this relation seems to be inverted in certain subgroups of (biologically) older individuals.…”

Section: Risk Of Functional Disabilitiesmentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

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A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

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“…For studies focused on the very elderly, most studies rely on cross-sectional data [19–21] and less sensitive measures of global cognition [20–22]. Studies that looked at the relationship between blood pressure and cognitive performance in the very elderly found that a lower SBP was associated with greater cognitive dysfunction both cross-sectionally and longitudinally, while higher blood pressure was associated with better cognitive performance [20–22], however, these studies relied on HTN measures acquired at old age and a single composite cognitive score.…”

Section: Introductionmentioning

confidence: 99%

Midlife Hypertension Risk and Cognition in the Non-Demented Oldest Old: Framingham Heart Study

Nishtala

Himali

Beiser

et al. 2015

JAD

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Midlife cardiovascular risk, hypertension (HTN) in particular, has been related cross-sectionally to poorer neuropsychological (NP) performance in middle age and older adults. This study investigated whether a similar relationship persists between midlife HTN or systolic blood pressure (SBP) and NP performance approximately 30 years later. 378 Framingham stroke and dementia-free Original cohort participants, with HTN and SBP ascertained between 50-60 years of age (mean age 55 ± 1, 65% women), were administered a NP assessment at age ≥80 years. Tests included Logical Memory, Visual Reproduction, Paired Associate, Hooper Visual Organization Test, Trail Making A & B, Digit Span Forward and Backward, Controlled Word Association Test (COWAT), and Similarities. Multivariable linear regression, adjusted for age, time interval between risk factor and NP testing, gender, and premorbid intelligence, assessed association between midlife HTN/SBP and NP outcomes. Midlife HTN was not significantly associated with NP outcome measures. Midlife SBP was associated with poorer Digit Span Forward and COWAT performance (p < 0.05). No significant interaction of age on HTN/SBP to NP associations was found. There was a significant interaction between ApoE4 status and SBP in their effects on COWAT (p interaction = 0.074); SBP was negatively associated with COWAT only in those with the ApoE4 allele (p = 0.025). While midlife HTN is not associated with late life cognitive impairment, midlife SBP is related to late life attention and verbal fluency impairments, particularly among ApoE4+ individuals. These results offer insight into processes that are operative in the absence of overt cognitive impairment and dementia.

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Higher Blood Pressure Associated With Higher Cognition and Functionality Among Centenarians in Australia

Cited by 54 publications

References 24 publications

P2‐083: Age of Onset of Hypertension and Risk of Dementia in the Oldest‐old: The 90+ Study

P2‐083: Age of Onset of Hypertension and Risk of Dementia in the Oldest‐old: The 90+ Study

Treatment of Hypertension in the Oldest Old

Midlife Hypertension Risk and Cognition in the Non-Demented Oldest Old: Framingham Heart Study

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