Systolic Blood Pressure Variation and Mean Heart Rate Is Associated With Cognitive Dysfunction in Patients With High Cardiovascular Risk

Abstract

Abstract— Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to < 24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P <0.01, unadjusted). After adjustment, only SBP-CV ( P =0.0030) and mean HR ( P =0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10–1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18–1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT 00153101.

Late-Life Vascular Risk Factors and Alzheimer Disease Neuropathology in Individuals with Normal Cognition

“…Higher average HR was associated with lower odds of ADNP; and annual increases in HR corresponded to greater ADNP burden. Resting HR has clinical utility in cardiovascular disease populations and is associated with cognitive decline in post-stroke patients and individuals with high cardiovascular risk (44,45). Limited research has examined resting HR as it relates to aging and neurodegenerative disease although 1 study found higher resting HR to predict worse functional status in older adults independent of cardiovascular disease (46).…”

Long‐Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study

“…These measures have been used in previous studies of BP variability 13, 14, 15, 16, 17, 18. Average real variability (ARV) is the average absolute difference between successive BP measurements and, in contrast with SD and CV, it takes into account the order of the clinic visits at which BP was measured 19, 20.…”

“…In addition to BP levels, BP variability may be associated with cognitive function 12, 13, 14, 15, 16, 17, 18. BP variability consists of short‐term BP variability (eg, within 24 hours) and long‐term BP variability (eg, visit‐to‐visit BP variability) 19, 20.…”

“…The association between greater long‐term BP variability and lower cognitive function has been recently highlighted in European and Asian studies,13, 14, 15, 16, 17, 18 although reports from studies of US populations are limited. Cognitive function was assessed at a single time point in these European and Asian studies13, 14, 15 and, thus, it remains to be determined whether long‐term BP variability is associated with cognitive function only concurrently or whether it is also related to individual cognitive decline.…”

Cognitive Decline and Dementia

“…In this issue of Hypertension, Böhm et al 4 have analyzed ≈25 000 patients at high risk for cardiovascular disease, who had participated in hypertension trials. Patients with cognitive impairment at baseline were excluded, as were patients with uncontrolled hypertension (on-treatment blood pressure [BP] >160/100 mm Hg).…”