Visit‐to‐visit office blood pressure variability revisited in SPRINT

Nagai, Michiaki; Kario, Kazuomi

doi:10.1111/jch.14313

Cited by 3 publications

(1 citation statement)

References 29 publications

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“… 20 , 21 , 22 We calculated intraindividual BPV from the 4 BP measurements (eg, from 3‐, 6‐, 9‐, and 12‐month follow‐up visits) as variability independent of mean, a newer index of BPV uncorrelated with mean BP across visits. 23 , 24 Variability independent of mean was calculated as variability independent of mean=SD/mean x , where the power x was derived from nonlinear curve fitting of BP SD against mean BP using the nls package in R Project (R Foundation for Statistical Computing, Vienna, Austria), as previously described. 11 , 12 , 23 , 25 , 26 We conducted a bivariate correlation to confirm that BPV variability independent of mean was not significantly correlated with mean BP ( r =0.03, P =0.18).…”

Section: Methodsmentioning

confidence: 99%

Blood Pressure Variability and Cerebral Perfusion Decline: A Post Hoc Analysis of the SPRINT MIND Trial

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2023

JAHA

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Background Blood pressure variability (BPV) is predictive of cerebrovascular disease and dementia, possibly though cerebral hypoperfusion. Higher BPV is associated with cerebral blood flow (CBF) decline in observational cohorts, but relationships in samples with strictly controlled blood pressure remain understudied. We investigated whether BPV relates to change in CBF in the context of intensive versus standard antihypertensive treatment. Methods and Results In this post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial–Memory and Cognition in Decreased Hypertension) trial, 289 participants (mean, 67.6 [7.6 SD] years, 38.8% women) underwent 4 blood pressure measurements over a 9‐month period after treatment randomization (intensive versus standard) and pseudo‐continuous arterial spin labeling magnetic resonance imaging at baseline and ≈4‐year follow‐up. BPV was calculated as tertiles of variability independent of mean. CBF was determined for whole brain, gray matter, white matter, hippocampus, parahippocampal gyrus, and entorhinal cortex. Linear mixed models examined relationships between BPV and change in CBF under intensive versus standard antihypertensive treatment. Higher BPV in the standard treatment group was associated with CBF decline in all regions (ß comparing the first versus third tertiles of BPV in whole brain: −0.09 [95% CI, −0.17 to −0.01]; P =0.03), especially in medial temporal regions. In the intensive treatment group, elevated BPV was related to CBF decline only in the hippocampus (ß, −0.10 [95% CI, −0.18, −0.01]; P =0.03). Conclusions Elevated BPV is associated with CBF decline, especially under standard blood pressure–lowering strategies. Relationships were particularly robust in medial temporal regions, consistent with prior work using observational cohorts. Findings highlight the possibility that BPV remains a risk for CBF decline even in individuals with strictly controlled mean blood pressure levels. Registration URL: http://clinicaltrials.gov . Identifier: NCT01206062.

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Section: Methodsmentioning

confidence: 99%

Blood Pressure Variability and Cerebral Perfusion Decline: A Post Hoc Analysis of the SPRINT MIND Trial

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Nation

2023

JAHA

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Visit-to-Visit Blood Pressure Variability and Cognitive Decline in Apolipoprotein ɛ4 Carriers versus Apolipoprotein ɛ3 Homozygotes

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2023

JAD

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Background: Blood pressure variability (BPV) is associated with cognitive decline and Alzheimer’s disease (AD), but relationships with AD risk gene apolipoprotein (APOE) ɛ4 remain understudied. Objective: Examined the longitudinal relationship between BPV and cognitive change in APOE ɛ4 carriers and APOE ɛ3 homozygotes. Methods: 1,194 Alzheimer’s Disease Neuroimaging Initiative participants (554 APOE ɛ4 carriers) underwent 3-4 blood pressure measurements between study baseline and 12-month follow-up. Visit-to-visit BPV was calculated as variability independent of mean over these 12 months. Participants subsequently underwent ≥1 neuropsychological exam at 12-month follow-up or later (up to 156 months later). Composite scores for the domains of memory, language, executive function, and visuospatial abilities were determined. Linear mixed models examined the 3-way interaction of BPV×APOE ɛ4 carrier status x time predicting change in composite scores. Results: Higher systolic BPV predicted greater decline in memory (+1 SD increase of BPV: β= –0.001, p < 0.001) and language (β= –0.002, p < 0.0001) among APOE ɛ4 carriers, but not APOE ɛ3 homozygotes (memory: +1 SD increase of BPV: β= 0.0001, p = 0.57; language: β= 0.0001, p = 0.72). Systolic BPV was not significantly associated with change in executive function or visuospatial abilities in APOE ɛ4 carriers (ps = 0.08–0.16) or APOE ɛ3 homozygotes (ps = 0.48–0.12). Conclusion: Cognitive decline associated with high BPV may be specifically accelerated among APOE ɛ4 carriers.

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Blood Pressure Variability and Plasma Alzheimer’s Disease Biomarkers in the SPRINT Trial

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2024

Journal of Alzheimer’s Disease

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Background: Recent observational studies suggest higher blood pressure (BP) variability (BPV) is associated with Alzheimer’s disease (AD) biomarkers amyloid-beta (Aβ) and tau. Less is known about relationships in interventional cohorts with strictly controlled mean BP levels. Objective: Investigate the longitudinal relationship between BPV and change in plasma AD biomarkers under standard versus intensive BP treatment. Methods: In this post hoc analysis of the SPRINT trial, 457 participants (n = 206 in standard group, n = 251 in intensive group) underwent repeated BP measurement between baseline and 12-months follow-up, and venipuncture at baseline and median (IQR) 3.5 (3.0–4.0) years later to determine plasma AD biomarkers total tau and Aβ 1–42:Aβ 1–40 ratio. BPV was calculated as tertiles of variability independent of mean. Linear mixed models investigated the effect of BPV×time on AD biomarker levels. Results: Higher BPV was associated with increased levels of total tau in the standard group (β [95% CI] 1st versus 3rd tertiles of BPV: 0.21 [0.02, 0.41], p = 0.035), but not in the intensive group (β [95% CI] 1st versus 3rd tertiles of BPV: −0.02 [−0.19, 0.16], p = 0.843). BPV was not associated with Aβ 1–42:Aβ 1–40 ratio in either group. Mean BP was not associated with biomarkers. Conclusions: Higher BPV was associated with increased plasma total tau under standard BP treatment. Findings add new evidence to prior observational work linking BPV to AD pathophysiology and suggest that, despite strict control of mean BP, BPV remains a risk for pathophysiological change underlying risk for AD.

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Visit‐to‐visit office blood pressure variability revisited in SPRINT

Cited by 3 publications

References 29 publications

Blood Pressure Variability and Cerebral Perfusion Decline: A Post Hoc Analysis of the SPRINT MIND Trial

Blood Pressure Variability and Cerebral Perfusion Decline: A Post Hoc Analysis of the SPRINT MIND Trial

Visit-to-Visit Blood Pressure Variability and Cognitive Decline in Apolipoprotein ɛ4 Carriers versus Apolipoprotein ɛ3 Homozygotes

Blood Pressure Variability and Plasma Alzheimer’s Disease Biomarkers in the SPRINT Trial

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