Measurement-to-Measurement Blood Pressure Variability Is Related to Cognitive Performance

Abstract

The objective was to investigate the association between variability in blood pressure and cognitive function for sitting, standing and reclining blood pressure values, and variability derived from all 15 measures. In previous studies only sitting blood pressure values have been examined, and only a few cognitive measures have been employed. A secondary objective was to examine associations between blood pressure variability and cognitive performance in hypertensive individuals stratified by treatment success. Cross-sectional analyses were performed on 972 participants of the Maine Syracuse Study for whom 15 serial blood pressure clinic measures (5 sitting, 5 recumbant and 5 standing) were obtained, prior to testing of cognitive performance. Using all 15 measures, higher variability in systolic and diastolic blood pressure was associated with poorer performance on multiple measures of cognitive performance, independent of demographic factors, cardiovascular risk factors, and pulse pressure. When sitting, reclining and standing systolic blood pressure values were compared, only variability in standing blood pressure was related to measures of cognitive performance. However, for diastolic blood pressure, variability in all three positions was related to cognitive performance. Mean blood pressure values were weaker predictors of cognition. Furthermore, higher overall variability in both systolic and diastolic blood pressure was associated with poorer cognitive performance in unsuccessfully treated hypertensive individuals (with blood pressure ≥140/90 mmHg), but these associations were not evident in those with controlled hypertension.

Blood pressure (BP) assessment—from BP level to BP variability

“…Recent studies also suggest that increased BP variability is associated with poorer cognitive performance and worsening psychomotor speed and verbal memory [7,36]. Stabouli et al showed that increased SBP variability is closely associated with arterial stiffness (assessed by pulse wave velocity) in children and adolescents [37], which would suggest that increased BP variability may precede early vascular damage/ early onset of atherosclerosis.…”

“…Several recent studies in adult patients have demonstrated that an increased BP variability (short-term and/or long-term) also has a significant impact on TOD [3], cardiovascular morbidity [4], progression of kidney disease [5,6] and cognitive function [7,8], independent of the BP level.…”

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure

“…Health care clinics often use blood pressure (BP) measurements to assess patients’ risk for cardiovascular problems (Crichton et al, 2014). Patients with hypertension are at particular risk for stroke, vascular dementia, and Alzheimer disease (Peila et al, 2006; Posner et al, 2002).…”

“…In recent years, greater variability in BP measurements (ie, changes in BP at different time points) has been linked to a higher risk for stroke and other cardiovascular events (Floras, 2013; Rothwell, 2010; Rothwell et al, 2010). Because wide BP variability is found in patients with brain structure abnormalities (Gunstad et al, 2009; Nagai et al, 2011; Sabayan et al, 2013) or hypertensive cardiovascular complications (Kanemaru et al, 2001), Crichton et al (2014) suggested that BP variability also affects cognitive performance.…”

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

“…Also, we did not assess other cognitive outcomes which might be impacted by BP lowering drugs 35 and BPV. 36 Finally, although we adjusted for comorbidities and discerned drug use for hypertension from other uses, we cannot rule out indication biases. For example, it is possible that β-blockers were favored by prescribers for their cardiovascular benefits in patients with coronary disease and acute cardiovascular event history.…”