Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Cheng, Gang; He, Simin; He, Qiong; Xie, Xiaowei; Tang, Chengying; Xie, Qiaorong; Wu, Xihong; Jiang, Ni; Li, Chao; Min, Xianying; Yan, Yan

doi:10.18632/aging.203228

Cited by 9 publications

(7 citation statements)

References 57 publications

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“…Similar to our study, a cohort study of the elderly with a median age of 77 years conducted in the United States identified trajectories of increased, little changed, and declined SBP by hierarchical cluster analysis (Smitson et al, 2017). Cheng et al (2021) also demonstrated four unique BP/PP trajectories: normal, stabilized, elevated, and persistently high BP/PP in the Chinese elderly. In previous studies, the differences in the baseline characteristics and risk of heart disease and cerebrovascular disease among BP/PP trajectory groups were similar to our study (Smitson et al, 2017;Cheng et al, 2021).…”

Section: Discussionsupporting

confidence: 83%

“…Cheng et al (2021) also demonstrated four unique BP/PP trajectories: normal, stabilized, elevated, and persistently high BP/PP in the Chinese elderly. In previous studies, the differences in the baseline characteristics and risk of heart disease and cerebrovascular disease among BP/PP trajectory groups were similar to our study (Smitson et al, 2017;Cheng et al, 2021). Thus, the occurrence of lowered BP in our study should not be considered a complication of heart disease and cerebrovascular diseases.…”

Section: Discussionmentioning

confidence: 87%

“…However, it is acknowledged that CVRFs are not static but change with age during the life course, so the associations of CVRFs with cognitive impairment could alter over time (Walker et al, 2019). Thus, it is more meaningful to analyze the trajectories of changes in CVRFs over time to show the direction and magnitude of changes in CVRFs during the life course (Cheng et al, 2021). The latent growth mixed model (LGMM) can identify multiple unobserved subpopulations that respond similarly to repeated measures of CVRFs (Qiu et al, 2020) and describe the developmental trajectories of subpopulations over time.…”

Section: Introductionmentioning

confidence: 99%

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Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

Duan

Dang

Kang

et al. 2023

Front. Aging Neurosci.

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ObjectivesThis study aimed to investigate the relationship between long-term trajectories of changes in cardiovascular risk factors (CVRFs) and the risk of cognitive impairment among Chinese adults over 60 years old.MethodsData were obtained from the Chinese Longitudinal Healthy Longevity Survey 2005–2018. Cognitive function was evaluated longitudinally through the Chinese version of the Mini-Mental State Examination (C-MMSE), and cognitive impairment (C-MMSE ≤23) was used as the main outcome variable. The cardiovascular risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and body mass index (BMI), were continuously measured in the follow-up duration. The patterns of trajectories of changes in CVRFs were derived from the latent growth mixture model (LGMM). The Cox regression model was used to evaluate the cognitive impairment hazard ratio (HR) across different CVRF trajectories.ResultsA total of 5,164 participants aged ≥60 years with normal cognitive function at baseline were included in the study. After a median follow-up of 8 years, 2,071 participants (40.1%) developed cognitive impairment (C-MMSE ≤ 23). The four-class trajectories of SBP and BMI were obtained by means of LGMM, and the trajectories of DBP, MAP, and PP were grouped into a three-class subgroup. In the final adjusted Cox model, the lowered SBP [adjusted HR (aHR): 1.59; 95% CI: 1.17–2.16], lowered PP (aHR: 2.64; 95% CI: 1.66–4.19), and progressively obese (aHR: 1.28; 95% CI: 1.02–1.62) and stable slim (aHR: 1.13; 95% CI: 1.02–1.25) were associated with the higher risk of cognitive impairment. Low stable DBP (aHR: 0.80; 95% CI: 0.66–0.96) and elevated PP (aHR: 0.76; 95% CI: 0.63–0.92) decreased the risk for cognitive impairment among participants.ConclusionLowered SBP, lowered PP, progressive obesity, and stable slim increased the risk for cognitive impairment in the Chinese elderly. Low stable DBP and elevated PP were protective against cognitive impairment, but more DBP lowering and ≥25 mmHg growth in PP contributed to a higher risk of cognitive impairment. The findings have important implications for preventing cognitive impairment in elder adults based on the long-term trajectories of changes in CVRFs.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

Duan

Dang

Kang

et al. 2023

Front. Aging Neurosci.

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“…Three 30 or four 31 different PP trajectories were observed by different studies using GBTM, which allowed identification of distinct patterns of PP change as independent trajectory groups. The specific number of classes may be linked to the age range, follow‐up period and the number of studied samples 32 .…”

Section: Discussionmentioning

confidence: 99%

The association of pulse pressure change with memory decline in middle‐aged and older adults

Liu

Tian

Sun

et al. 2022

J American Geriatrics Society

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Background Less is known regarding the association of pulse pressure (PP) with memory function. This study aimed to characterize long‐term patterns of PP in middle‐aged and older adults and explore their impact on subsequent change in memory function. Methods Data from the English Longitudinal Study of Ageing (ELSA, 2004–2018), were analyzed. Totally, 3587 dementia‐free participants with three measurements of BP were included. All three visits of PP (2004–2012) were used to characterize longitudinal patterns of PP by group‐based trajectory modeling (GBTM). Generalized estimating equation (GEE) models were fitted to explore the impact of PP trajectories on change in memory over a subsequent 6‐year period (2012–2018). Results Using GBTM, three distinct trajectories of PP were identified: low‐stable (38.1%), moderate‐stable (48.6%), and elevated‐increasing group (13.3%). GEE model suggested that memory declined over a 6‐year period in all PP trajectories (all Ptime <0.001). The overall interactions between patterns of PP changes and time with memory were statistically significant (χ2interaction = 20.69, p = 0.002). Compared to participants in the low‐stable group, those in the moderate‐stable and elevated‐increasing group exhibited a faster decline in memory. Conclusions Longitudinal patterns of moderate‐stable and elevated‐increasing PP were associated with an accelerated decrease in memory. Controlling BP instability may be a promising interventional strategy for preventing cognitive decline among older adults.

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“… 31 Steep declines in BP preceding onset of dementia or clinical diagnosis of Alzheimer’s disease were also observed in the Kungsholmen project 32 , 33 and in those over 78 years in the Adult Changes in Thought Study ( n = 2356). 34 Cheng et al 35 calculated that the risk of developing dementia was highest when hypertension was ‘stabilized’ and lowest in participants with normal BP who developed hypertension over the 6-year study period. In very late life, hypertension is protective against dementia.…”

Section: Introductionmentioning

confidence: 99%

Elevated late-life blood pressure may maintain brain oxygenation and slow amyloid-β accumulation at the expense of cerebral vascular damage

Tayler

MacLachlan

Guzel

et al. 2023

Brain Communications

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Hypertension in midlife contributes to cognitive decline and is a modifiable risk factor for dementia. The relationship between late-life hypertension and dementia is less clear. We have investigated the relationship of blood pressure and hypertensive status during later life (after 65 y) to post-mortem markers of Alzheimer's disease (amyloid-β and tau loads), arteriolosclerosis and cerebral amyloid angiopathy; and to biochemical measures of ante-mortem cerebral oxygenation (the myelin-associated glycoprotein:proteolipid protein-1 ratio, which is reduced in chronically hypoperfused brain tissue, and the level of vascular endothelial growth factor-A, which is upregulated by tissue hypoxia), blood-brain barrier damage (indicated by an increase in parenchymal fibrinogen), and pericyte content (platelet-derived growth factor receptor β which declines with pericyte loss) in Alzheimer's disease (n = 75), vascular (n = 20), and mixed dementia (n = 31) cohorts. Systolic and diastolic blood pressure measurements were obtained retrospectively from clinical records. Non-amyloid small vessel disease and cerebral amyloid angiopathy were scored semi-quantitatively. Amyloid-β and tau loads were assessed by field fraction measurement in immunolabelled sections of frontal and parietal lobes. Homogenates of frozen tissue from the contralateral frontal and parietal lobes (cortex and white matter) were used to measure markers of vascular function by enzyme-linked immunosorbent assay. Diastolic (but not systolic) blood pressure was associated with preservation of cerebral oxygenation, correlating positively with the ratio of myelin-associated glycoprotein to proteolipid protein-1 and negatively with vascular endothelial growth factor-A in both frontal and parietal cortex. Diastolic blood pressure correlated negatively with parenchymal amyloid-β in the parietal cortex. In dementia cases, elevated late-life diastolic blood pressure was associated with more severe arteriolosclerosis and cerebral amyloid angiopathy, and diastolic blood pressure correlated positively with parenchymal fibrinogen, indicating blood-brain barrier breakdown, in both regions of cortex. Systolic blood pressure was related to lower platelet-derived growth factor receptor β in controls in the frontal cortex, and in dementia cases in the superficial white matter. We found no association between blood pressure and tau. Our findings demonstrate a complex relationship between late-life blood pressure, disease pathology, and vascular function in dementia. We suggest that hypertension helps to reduce cerebral ischaemia (and may slow β-amyloid accumulation) in the face of increasing cerebral vascular resistance, but exacerbates vascular pathology.

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Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

Cited by 9 publications

References 57 publications

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

The association of pulse pressure change with memory decline in middle‐aged and older adults

Elevated late-life blood pressure may maintain brain oxygenation and slow amyloid-β accumulation at the expense of cerebral vascular damage

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