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Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline.

ABSTRACT: The association between visit-to-visit variability of blood pressure (BP) and cognitive decline over time remains incompletely understood in a general population of older adults. We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. This prospective cohort study comprised 976 adults who had 3 or 4 visits with BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed cognitive screening tests at ?2 visits in 1997, 2000, or 2004. Visit-to-visit BP variability was expressed as the SD, coefficient of variation, or as the variation independent of mean BP across visits conducted at a mean interval of 3.2 years. Mean (SD) age at the first cognitive test was 64 (6) years. Using multivariable-adjusted linear mixed-effects models, we found higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% confidence interval] for high versus low tertile of SD variability: standardized composite scores -0.038 standard units (SU)/y [-0.066 to -0.009] and verbal memory -0.041 SU/y [-0.075 to -0.008]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of cognitive function, independent of mean diastolic BP, among adults aged 55 to 64 years but not those ?65 years. Our results suggest that higher long-term BP visit-to-visit variability is associated with a faster rate of cognitive decline among older adults.

SUBMITTER: Qin B

PROVIDER: S-EPMC4900904 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline.

Qin Bo B Viera Anthony J AJ Muntner Paul P Plassman Brenda L BL Edwards Lloyd J LJ Adair Linda S LS Popkin Barry M BM Mendez Michelle A MA

Hypertension (Dallas, Tex. : 1979) 20160523 1

The association between visit-to-visit variability of blood pressure (BP) and cognitive decline over time remains incompletely understood in a general population of older adults. We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. This prospective cohort study comprised 976 adults who had 3 or 4 visits with BP measurements as part of the China Health and Nutr ...[more]

PMID: 27217401

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Project description:ImportanceLong-term blood pressure (BP) variability has emerged as a reproducible measure that is associated with heart failure independent of systemic BP. Visit-to-visit BP variability may be associated with the risk of heart failure early in the life course and thus may be reflected in subclinical alterations in cardiac structure and function.ObjectiveTo evaluate the association between visit-to-visit BP variability in early adulthood and myocardial structure and function in middle age.Design, setting, and participantsThis cohort study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a community-based cohort study of 5115 participants aged 18 to 30 years at baseline (year 0; March 25, 1985, to June 7, 1986) and followed up over a 30-year interval. A total of 2400 CARDIA study participants underwent evaluation at 4 field sites (Birmingham, Alabama; Oakland, California; Chicago, Illinois; and Minneapolis, Minnesota). Blood pressure was measured at 8 visits over a 25-year interval and participants received echocardiograms at year 25 (June 1, 2010, to August 31, 2011). Data analysis was conducted from June 7, 1986, to August 31, 2011.ExposuresVisit-to-visit systolic and diastolic BP variability measures included SD, average real variability, and variability independent of the mean.Main outcomes and measuresEchocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 25 examination.ResultsOf the 2400 participants, 1024 were men (42.7%) and 976 were African American (40.7%); mean (SD) age at the year 25 examination was 50.4 (3.6) years. Per 1-SD increment, greater visit-to-visit systolic BP variability independent of the mean was associated with higher left-ventricular (LV) mass index (β [SE], 2.66 [0.4] g/m2, P < .001), worse diastolic function (early peak diastolic mitral annular velocity [é]) (β [SE], -0.40 [0.1] cm/s, P < .001), higher LV filling pressures (mitral inflow velocity to early diastolic mitral annular velocity [E/é]) β [SE], 0.37 [0.1] cm/s, P < .001), and worse global longitudinal strain (β [SE], 0.17 [0.1], P = .002). Similarly, greater visit-to-visit diastolic BP variability was associated with higher LV mass index (β [SE], 3.21 [0.5] g/m2, P < .001), worse diastolic function (é: β [SE], -0.24 [0.1] cm/s [P < .001]; E/é: β [SE], 0.23 [0.1] cm/s [P < .001]), and worse global longitudinal strain (β [SE], 0.13 [0.1], P = .02). The findings remained consistent when other BP variability measures were used (SD and average real variability).Conclusions and relevanceIn this cohort study using data from the CARDIA study, greater visit-to-visit systolic and diastolic BP variability have been associated with adverse alterations in cardiac structure as well as systolic and diastolic function independent of mean BP levels.

Dataset Information

Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline.

Publications

Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline.

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