open access

Vol 22, No 3 (2018)
Original paper
Published online: 2018-09-13
Get Citation

The association between cognitive decline and short-term blood pressure variability in middle-aged patients with primary hypertension — a pilot study

Jakub Baranowski1, Karol Klęczar1, Marta Sołtysiak2, Krystyna Widecka2
·
Arterial Hypertension 2018;22(3):135-142.
Affiliations
  1. Students Scientific Association of Department of Internal Diseases and Hypertensiology, Szczecin, Poland
  2. Department of Internal Diseases and Hypertensiology, Pomeranian Medical University, Szczecin, Poland

open access

Vol 22, No 3 (2018)
ORIGINAL PAPERS
Published online: 2018-09-13

Abstract

Introduction. Hypertension (HTN) is a common cause of cognitive dysfunction. Current data emphasize a role of HTN in the development of unfavourable vascular remodelling and changes in cerebral microcirculation, leading to cognitive decline. In this study, we sought associations between circadian blood pressure variability (BPV) in a 24h blood pressure ambulatory monitoring (ABPM) and cognitive decline in middle-aged hypertensive patients.

Material and methods. The study group comprised 42 patients with uncomplicated hypertension (24 females, 18 males; mean age: 59.1 ± 6.1 years). BPV was assessed by ABPM and expressed in standard deviation (24 MAP SD) and coefficient of variation (CV). Cognitive performance was evaluated using Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and Montreal Assessment Cognitive Scale (MoCA).

Results. In the whole study group, MMSE and CDT scores were within the normal range, but the mean scores were lowered in the MoCA test. All of the neuropsychological test scores were comparable in groups with normal and abnormal (non-dipper) blood pressure patterns. Among the analyzed BPV indicators, CV was negatively correlated with CDT and MoCA scores. 24 MAP expressed in standard deviations was also negatively correlated with CDT scores. In the multivariate analysis, MoCA scores were inversely associated with CV after adjusting for age, gender, education and abnormal lipid profiles. Mean MoCA scores were significantly lower in men in comparison to women.

Conclusions. In this pilot-based study, mild cognitive impairment in middle-aged patients with long-lasting uncomplicated hypertension may be associated with increased diurnal variability of blood pressure.

Abstract

Introduction. Hypertension (HTN) is a common cause of cognitive dysfunction. Current data emphasize a role of HTN in the development of unfavourable vascular remodelling and changes in cerebral microcirculation, leading to cognitive decline. In this study, we sought associations between circadian blood pressure variability (BPV) in a 24h blood pressure ambulatory monitoring (ABPM) and cognitive decline in middle-aged hypertensive patients.

Material and methods. The study group comprised 42 patients with uncomplicated hypertension (24 females, 18 males; mean age: 59.1 ± 6.1 years). BPV was assessed by ABPM and expressed in standard deviation (24 MAP SD) and coefficient of variation (CV). Cognitive performance was evaluated using Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and Montreal Assessment Cognitive Scale (MoCA).

Results. In the whole study group, MMSE and CDT scores were within the normal range, but the mean scores were lowered in the MoCA test. All of the neuropsychological test scores were comparable in groups with normal and abnormal (non-dipper) blood pressure patterns. Among the analyzed BPV indicators, CV was negatively correlated with CDT and MoCA scores. 24 MAP expressed in standard deviations was also negatively correlated with CDT scores. In the multivariate analysis, MoCA scores were inversely associated with CV after adjusting for age, gender, education and abnormal lipid profiles. Mean MoCA scores were significantly lower in men in comparison to women.

Conclusions. In this pilot-based study, mild cognitive impairment in middle-aged patients with long-lasting uncomplicated hypertension may be associated with increased diurnal variability of blood pressure.

Get Citation

Keywords

cognitive decline, blood pressure variability, hypertension

About this article
Title

The association between cognitive decline and short-term blood pressure variability in middle-aged patients with primary hypertension — a pilot study

Journal

Arterial Hypertension

Issue

Vol 22, No 3 (2018)

Article type

Original paper

Pages

135-142

Published online

2018-09-13

Page views

1155

Article views/downloads

893

DOI

10.5603/AH.a2018.0013

Bibliographic record

Arterial Hypertension 2018;22(3):135-142.

Keywords

cognitive decline
blood pressure variability
hypertension

Authors

Jakub Baranowski
Karol Klęczar
Marta Sołtysiak
Krystyna Widecka

References (62)
  1. Mamcarz A, Mastalerz-Migas A, Mirowska-Guzel D, et al. Stanowisko interdyscyplinarnego zespołu ekspertów dotyczące leczenia pacjentów z nadciśnieniem tętniczym łistniejącymi zaburzeniami funkcji poznawczych w codziennej praktyce lekarskiej. Arterial Hypertens. 2017; 4: 153–166.
  2. Ivan CS, Seshadri S, Beiser A, et al. Dementia after stroke: the Framingham Study. Stroke. 2004; 35(6): 1264–1268.
  3. O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003; 2(2): 89–98.
  4. Poggesi A, Pantoni L, Inzitari D, et al. LADIS Study Group, The LADIS Study Group. 2001-2011: A Decade of the LADIS (Leukoaraiosis And DISability) Study: What Have We Learned about White Matter Changes and Small-Vessel Disease? Cerebrovasc Dis. 2011; 32(6): 577–588.
  5. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. The Lancet Neurology. 2010; 9(7): 689–701.
  6. Sierra C, de la Sierra A, Chamorro A, et al. Silent cerebral white matter lesions in middle-aged essential hypertensive patients. J Hypertens. 2002; 20(3): 519–524.
  7. Wong TY, Klein R, Sharrett AR, et al. Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study. Stroke. 2002; 33(6): 1487–1492.
  8. Inaba S, Iwai M, Furuno M, et al. Continuous activation of renin-angiotensin system impairs cognitive function in renin/angiotensinogen transgenic mice. Hypertension. 2009; 53(2): 356–362.
  9. Głuszek J, Jankowska K. Zmiany otępienne wywołane nadciśnieniem tętniczym. Choroby Serca Naczyń. 2005; 3: 125–130.
  10. Birns J, Morris R, Donaldson N, et al. The effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials. J Hypertens. 2006; 24(10): 1907–1914.
  11. Elias PK, Elias MF, Robbins MA, et al. Blood pressure-related cognitive decline: does age make a difference? Hypertension. 2004; 44(5): 631–636.
  12. Richard E, Reitz C, Honig LH, et al. Relation of diabetes to mild cognitive impairment. Arch Neurol. 2007; 64(4): 570–575.
  13. Shang S, Li P, Deng M, et al. The Age-Dependent Relationship between Blood Pressure and Cognitive Impairment: A Cross-Sectional Study in a Rural Area of Xi'an, China. PLoS One. 2016; 11(7): e0159485.
  14. Zou Y, Zhu Q, Deng Y, et al. Vascular risk factors and mild cognitive impairment in the elderly population in Southwest China. Am J Alzheimers Dis Other Demen. 2014; 29(3): 242–247.
  15. Gelber RP, Ross GW, Petrovitch H, et al. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA. 1995; 274(23): 1846–1851.
  16. Li Ge, Rhew IC, Shofer JB, et al. Age-varying association between blood pressure and risk of dementia in those aged 65 and older: a community-based prospective cohort study. J Am Geriatr Soc. 2007; 55(8): 1161–1167.
  17. Cacciatore F, Abete P, Ferrara N, et al. The role of blood pressure in cognitive impairment in an elderly population. Osservatorio Geriatrico Campano Group. J Hypertens. 1997; 15(2): 135–142.
  18. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension. 1998; 31(3): 780–786.
  19. Razay G, Williams J, King E, et al. Blood pressure, dementia and Alzheimer's disease: the OPTIMA longitudinal study. Dement Geriatr Cogn Disord. 2009; 28(1): 70–74.
  20. Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996; 347(9009): 1141–1145.
  21. Dore GA, Elias MF, Crichton GE, et al. Age modifies the relation between intraindividual measurement-to-measurement variation in blood pressure and cognitive function: the Maine-Syracuse Study. J Hypertens. 2018; 36(2): 268–276.
  22. Mergeani AC, Antochi F, Rusu O, et al. Correlations of Cognitive Impairment with Circadian Blood Pressure Pattern and Intima-Media Thickness in Hypertensive Patients. Maedica (Buchar). 2015; 10(4): 325–330.
  23. van Boxtel MP, Gaillard C, Houx PJ, et al. Is nondipping in 24 h ambulatory blood pressure related to cognitive dysfunction? J Hypertens. 1998; 16(10): 1425–1432.
  24. Guo H, Tabara Y, Igase M, et al. Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study. Hypertens Res. 2010; 33(1): 32–36.
  25. Komori T, Eguchi K, Saito T, et al. Riser Blood Pressure Pattern Is Associated With Mild Cognitive Impairment in Heart Failure Patients. Am J Hypertens. 2016; 29(2): 194–201.
  26. Angeli F, Reboldi G, Verdecchia P. Interpretation of ambulatory blood pressure profile: a prognostic approach for clinical practice. J Hypertens. 2015; 33(3): 454–457.
  27. Yaneva-Sirakova T, Tarnovska-Kadreva R, Traykov L. Pulse pressure and mild cognitive impairment. J Cardiovasc Med (Hagerstown). 2012; 13(11): 735–740.
  28. Yasar S, Ko JY, Nothelle S, et al. Evaluation of the effect of systolic blood pressure and pulse pressure on cognitive function: the Women's Health and Aging Study II. PLoS One. 2011; 6(12): e27976.
  29. Riba-Llena I, Nafría C, Filomena J, et al. High daytime and nighttime ambulatory pulse pressure predict poor cognitive function and mild cognitive impairment in hypertensive individuals. J Cereb Blood Flow Metab. 2016; 36(1): 253–263.
  30. Tykarski A, Narkiewicz K, Gaciong Z, et al. Guidelines for the Management of Hypertension. Arterial Hypertension. 2015; 19(2): 53–83.
  31. Gąsecki D, Kwarciany M, Nyka W, et al. Hypertension, brain damage and cognitive decline. Curr Hypertens Rep. 2013; 15(6): 547–558.
  32. Elias MF, Wolf PA, D'Agostino RB, et al. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993; 138(6): 353–364.
  33. Whitmer RA, Sidney S, Selby J, et al. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology. 2005; 64(2): 277–281.
  34. Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005; 4(8): 487–499.
  35. Gelber RP, Ross GW, Petrovitch H, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging. 2000; 21(1): 49–55.
  36. Yamada M, Shimizu M, Kasagi F, et al. Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. J Am Geriatr Soc. 2003; 51(3): 410–414.
  37. Mancia G, Fagard R, Narkiewicz K, et al. Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology, ESH/ESC Task Force for the Management of Arterial Hypertension, Task Force Members, Task Force for the management of arterial hypertension of the European Society of Hypertension, Task Force for the management of arterial hypertension of the European Society of Cardiology. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34(28): 2159–2219.
  38. Tykarski A, Narkiewicz K, Gaciong Z, et al. Zasady postępowania w nadciśnieniu tętniczym — 2015 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego — wersja skrócona. Kardiologia Polska. 2015; 73(8): 676–700.
  39. Angeli F, Reboldi G, Verdecchia P. Interpretation of ambulatory blood pressure profile: a prognostic approach for clinical practice. J Hypertens. 2015; 33(3): 454–457.
  40. Verdecchia P, Angeli F. Natural history of hypertension subtypes. Circulation. 2005; 111(9): 1094–1096.
  41. Verdecchia P, Angeli F. [The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the weapons are ready]. Rev Esp Cardiol. 2003; 56(9): 843–847.
  42. Waldstein SR, Katzel LI. Hypertension and cognitive function. In: Waldstein SR, Elias MF, eds. Neuropsychology of Cardiovascular Disease.Mahawah NJ. ed. Mahwah, NJ: Lawrence Erlbaum Associates : 15–36.
  43. Elias MF, Robbins MA, Schultz NR, et al. Is blood pressure an important variable in research on aging and neuropsychological test performance? J Gerontol. 1990; 45(4): P128–P135.
  44. Nagai M, Hoshide S, Ishikawa J, et al. Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension. J Hypertens. 2008; 26(8): 1636–1641.
  45. Sander D, Winbeck K, Klingelhöfer J, et al. Extent of cerebral white matter lesions is related to changes of circadian blood pressure rhythmicity. Arch Neurol. 2000; 57(9): 1302–1307.
  46. Kario K, Matsuo T, Kobayashi H, et al. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension. 1996; 27(1): 130–135.
  47. Townsend RE, Prinz PN, Obrist WD. Human cerebral blood flow during sleep and waking. J Appl Physiol. 1973; 35(5): 620–625.
  48. Metoki H, Ohkubo T, Kikuya M, et al. Influence of age on the nocturnal fall of blood pressure and its modulation by long-acting calcium antagonists. Clin Exp Hypertens A. 1990; 12(6): 1077–1094.
  49. Bellelli G, Pezzini A, Bianchetti A, et al. Increased blood pressure variability may be associated with cognitive decline in hypertensive elderly subjects with no dementia. Arch Intern Med. 2002; 162(4): 483–484.
  50. Sohn D, Shpanskaya K, Lucas JE, et al. Sex Differences in Cognitive Decline in Subjects with High Likelihood of Mild Cognitive Impairment due to Alzheimer's disease. Sci Rep. 2018; 8(1): 7490.
  51. Lin KA, Choudhury KR, Rathakrishnan BG, et al. Alzheimer's Disease Neuroimaging Initiative. Marked gender differences in progression of mild cognitive impairment over 8 years. Alzheimers Dement (N Y). 2015; 1(2): 103–110.
  52. Barnes LL, Wilson RS, Bienias JL, et al. Sex differences in the clinical manifestations of Alzheimer disease pathology. Arch Gen Psychiatry. 2005; 62(6): 685–691.
  53. Irvine K, Laws KR, Gale TM, et al. Greater cognitive deterioration in women than men with Alzheimer's disease: a meta analysis. J Clin Exp Neuropsychol. 2012; 34(9): 989–998.
  54. Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer's disease: assessing sex and gender differences. Clin Epidemiol. 2014; 6: 37–48.
  55. Henderson VW, Paganini-Hill A, Miller BL, et al. Estrogen deficiency and risk of Alzheimer's disease in women. Am J Epidemiol. 1994; 140(3): 256–261.
  56. Wang L, Tian T. Alzheimer’s Disease Neuroimaging Initiative. Gender Differences in Elderly With Subjective Cognitive Decline. Front Aging Neurosci. 2018; 10: 166.
  57. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695–699.
  58. Popović IM, Serić V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci. 2007; 257(1-2): 185–193.
  59. Wong A, Xiong YY, Kwan PWL, et al. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord. 2009; 28(1): 81–87.
  60. Dong Y, Sharma VK, Chan BPL, et al. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci. 2010; 299(1-2): 15–18.
  61. Maylor EA, Reimers S, Choi J, et al. Gender and sexual orientation differences in cognition across adulthood: age is kinder to women than to men regardless of sexual orientation. Arch Sex Behav. 2007; 36(2): 235–249.
  62. Roberts RO, Geda YE, Knopman DS, et al. The incidence of MCI differs by subtype and is higher in men: the Mayo Clinic Study of Aging. Neurology. 2012; 78(5): 342–351.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl