Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

Annals of Family Medicine
13 Mar, 2019 ,

Sven Streit, MD, MSc, PhD et al investigated whether 1-year alterations in cognitive/daily functioning or quality of life (QoL) in persons aged ≥ 75 years with or without complex health problems may be related to systolic blood pressure (SBP) in patients undergoing antihypertensive treatment. For this purpose, they used data from Integrated Systematic Care for Older Persons—a population-based, prospective cohort study with a 1-year follow-up period. Less cognitive decline after 1 year, without loss of daily functioning or QoL, was observed among participants in this study sample, with SBP ≥ 130 mmHg vs < 130 mmHg. These effects were most pronounced in those with complex health problems.

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Systolic blood pressure and cognitive decline in older adults with hypertension

Annals of Family Medicine — Streit S, et al. | March 13, 2019

Abstract

PURPOSE 

Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems.

METHODS 

We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty.

RESULTS 

Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP <130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP >150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend <.001), not in those without (P for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment.

CONCLUSIONS 

Participants aged ≥75 years undergoing antihypertensive treatment, with SBP ≥130 mm Hg compared to <130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.