Midlife Pulse Pressure and Incidence of Dementia

Abstract

Background and Purpose-Previous studies have shown that midlife systolic blood pressure (SBP) predicts late-life cognitive decline and incident dementia. This study explores whether this association is attributable to the pulsatile, ie, pulse pressure (PP), or the nonpulsatile component of blood pressure (BP). Methods-Data are from the Honolulu-Asia Aging Study, a community-based study of Japanese American men. Midlife BP was measured in 1971 to 1974 and dementia assessment was conducted in late-life. The 2505 men who were dementia free in 1991 and had complete follow-up data were re-examined for incident dementia in 1994 to 1996 and 1997 to 1999. Their age ranged from 71 to 93 years. Survival analysis with age as the time scale was performed to estimate the risk (hazard ratio [HR] and 95% CI) for incident dementia associated with mid-and late-life tertiles of PP and mean arterial BP, as well as SBP and diastolic BP categories. Results-Over a mean of 5.1 years of follow-up, 189 cases (7.5%) of incident Alzheimer disease or vascular dementia were identified. After adjustment for cerebrovascular risk factors, dementia was significantly associated with SBP (HR 1.77; 95% CI, 1.10 to 2.84, for SBP Ն140 mm Hg compared with SBP Ͻ120 mm Hg), but not with PP tertiles. Limiting the analysis to those never treated with antihypertensives, high levels of all 4 BP components were significantly associated with dementia. In models with 2 BP components, only SBP remained significant in both the total sample and the never-treated subgroup (HR 2.29; 95% CI, 1.23 to 4.25, for SBP Ն140 mm Hg in total sample), whereas PP was not significantly associated with the risk for dementia. Conclusions-Midlife PP is not independently associated with dementia incidence. Midlife SBP is the strongest BP component predicting incident dementia. (Stroke. 2006;37:33-37.)

Ausência de relação entre hipertensão arterial sistêmica e desempenho cognitivo em idosos de uma comunidade

“…A ausência de relação entre hipertensão arterial e declínio cognitivo pode ocorrer se o uso de medicação anti-hipertensiva for frequente na população estudada 8 .…”

“…Ao contrário de alguns relatos [5][6][7][8] , neste estudo não foi encontrada relação estatisticamente significativa entre hipertensão arterial e declínio cognitivo. Conforme o esperado, as análises demonstraram que os níveis mais baixos de desempenho cognitivo foram encontrados em indivíduos mais velhos e com menor escolaridade.…”

“…Os resultados deste estudo se contrapõem com o estudo de Freitag et al 8 , que encontrou associação entre pressão arterial sistólica e declínio cognitivo e demência. O estudo de Cervilla et al 5 também encontrou relação entre pressão arterial sistólica e desempenho cognitivo e sugere que a redução da pressão arterial sistólica pode prevenir esse declínio.…”

“…Alguns estudos longitudinais [5][6][7][8] encontraram relação significativa entre a hipertensão arterial sistêmica e o declínio cognitivo em idosos, por outro lado, outros estudos, também longitudinais, não encontraram essa relação 9,10 .…”

Vascular mechanisms of cognitive impairment: roles of hypertension and subsequent small vessel disease under sympathetic influences

“…The Honolulu-Asia Aging Study-which tracked 2505 men, ages ranging from 71 to 93 years old, who were dementia-free over a mean of 5.1 years-demonstrated that dementia was significantly associated with high systolic BP, but not with pulse pressure. 19 Hypertension may be expected to predispose patients to the development of small vessel diseases, such as silent lacunar infarcts or white matter lesions, leading to cognitive impairment and finally, dementia. 20 Conversely, it has also been reported that relatively low BP is related to higher prevalence of dementia.…”