Visit-to-Visit Variability in BP Associated with Dementia, Cognitive Decline

September 3, 2020

"Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia," conclude authors of a new study.

Blood pressure variability (BPV) from visit-to-visit is associated with cognitive decline and dementia, according to a new study published in Hypertension.

Researchers led by Laure Rouch, PhD, PharmD, Paris Descartes University in France found that higher visit-to-visit systolic and diastolic BPV as well as variability in mean arterial pressure (MAP) were all associated with poor cognition and increased risk of dementia. There was an association observed between baseline blood pressure values and poor cognition but not with increased risk in dementia.

BPV universally dangerous

It is only recently, the authors note, that the clinical relevance of BPV has been considered. "However, over the past decade, higher BPV has been increasingly recognized as a predictor of clinical events, such as stroke, myocardial infarction and cardiovascular and all-cause mortality," the authors wrote. "BPV has also been associated with lower hippocampal volume, presence of cerebral microbleeds, cortical infarcts, and white matter hyperintensities.”

To study the potential relationship between BPV and cognitive decline and incident dementia Rouch et al recruited 3319 noninstitutionalized adults aged 65 years and older from Sujets AGÉS (aged subjects); 57% were women. Participants underwent clinical examinations every 6 months for a period of 3 years. Six metrics of visit-to-visit variability were applied to evaluate BP change over time; cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders.Linear mixed models and Cox proportional hazards models were used. Results showed:

  • Higher visit-to-visit systolic BPV was associated with poorer cognition independently of baseline SBP (adjusted 1-SD increase of coefficient of variation: β [SE]=−0.12 [0.06], P=0.04)
  • Higher diastolic BPV and mean arterial pressure variability were similarly associated with cognitive decline (β [SE] =−0.20 [0.06],P<.001 for both)
  • Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD (P=0.02).
  • Among the 3319 subjects, 93 (2.8%) developed dementia
  • Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: HRs=1.23 [95% CI, 1.01–1.50], P=0.04)
  • Higher diastolic BPV and mean arterial pressure variability were similarly associated with risk of dementia (P<0.01).
  • Pulse pressure variability was not associated with dementia risk.

“Our results emphasize the importance of focusing not only on blood pressure values but also on visit-to-visit BPV that could be an even better marker to identify patients at risk for developing cognitive impairment and dementia,” the authors wrote. “Further studies are needed to assess whether controlling blood pressure instability could be a promising interventional target in preserving cognition among older adults.”