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Popiołek AK, Niznikiewicz MA, Borkowska A, Bieliński MK. Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09642-5. [PMID: 38564137 DOI: 10.1007/s10484-024-09642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.
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Affiliation(s)
- Alicja K Popiołek
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland.
| | - Margaret A Niznikiewicz
- Medical Center, Harvard Medical School and Boston VA Healthcare System, Psychiatry 116a C/O R. McCarly 940 Belmont St, Brockton, MA, 02301, USA
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland
| | - Maciej K Bieliński
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland
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2
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Massengale K, Barnes VA, Williams C, Mansuri A, Norland K, Altvater M, Bailey H, Harris RA, Su S, Wang X. Nocturnal blood pressure dipping, blood pressure variability, and cognitive function in early and middle-aged adults. J Clin Hypertens (Greenwich) 2024; 26:235-240. [PMID: 38332546 PMCID: PMC10918738 DOI: 10.1111/jch.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024]
Abstract
Higher nighttime blood pressure (BP), less BP dipping, and higher BP variability have been linked with worse cognitive function in the elderly. The goal of this study is to explore whether this relationship already exists in early and middle adulthood. We further examined whether ethnic differences between African Americans and European Americans in BP parameters can explain ethnic differences in cognitive function. 24-h ambulatory BP monitoring and cognitive function were obtained from 390 participants (average age: 37.2 years with a range of 25-50; 54.9% African Americans; 63.6% females). We observed that higher nighttime BP, decreased dipping, and higher variability were significantly associated with lower scores on the Picture Sequence Memory Test. Significant negative associations between variability and overall composite scores were also observed. No significant associations between average 24-h or daytime BP and cognitive function were observed. Ethnic differences in nighttime diastolic pressures and dipping can explain 6.81% to 10.8% of the ethnicity difference in the score of the Picture Sequence Memory Test (ps < .05). This study suggests that the associations of nighttime BP, dipping, and variability with cognitive function already exist in young and middle-aged adults. Ethnic differences in nighttime BP and dipping can at least partially explain ethnic differences in cognitive function. The stronger association of these parameters with cognitive function than daytime or average BP in this age range raises the importance of using ambulatory BP monitoring for more precise detection of abnormal BP patterns in young adulthood.
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Affiliation(s)
| | - Vernon A. Barnes
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Celestin Williams
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Asifhusen Mansuri
- Division of Pediatric Nephrology and HypertensionChildren's Hospital of GeorgiaMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Kimberly Norland
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Michelle Altvater
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Hallie Bailey
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Ryan A. Harris
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Xiaoling Wang
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
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3
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Angeli F, Reboldi G, Solano FG, Prosciutto A, Paolini A, Zappa M, Bartolini C, Santucci A, Coiro S, Verdecchia P. Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The 'Ambulatory Does Prediction Valid (ADPV)' Approach. Diagnostics (Basel) 2023; 13:diagnostics13091601. [PMID: 37174992 PMCID: PMC10178200 DOI: 10.3390/diagnostics13091601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability).
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy
- Division of Nephrology, Hospital S. Maria della Misericordia, 33100 Perugia, Italy
| | | | | | | | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Claudia Bartolini
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Andrea Santucci
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Stefano Coiro
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy
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4
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Gavriilaki M, Anyfanti P, Mastrogiannis K, Gavriilaki E, Lazaridis A, Kimiskidis V, Gkaliagkousi E. Association between ambulatory blood pressure monitoring patterns with cognitive function and risk of dementia: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:745-761. [PMID: 36995461 PMCID: PMC10115699 DOI: 10.1007/s40520-023-02361-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The objective of this systematic review and meta-analysis is to investigate whether nocturnal blood pressure fall, expressed by dipping patterns according to 24 h ambulatory blood pressure monitoring (ABPM), is associated with abnormal cognitive function (cognitive impairment or dementia). METHODS We systematically searched PubMed, Embase, and Cochrane databases to identify original articles through December 2022. We included any study with at least ten participants reporting on all-cause dementia or cognitive impairment incidence (primary outcome) or validated cognitive tests (secondary outcome) among ABPM patterns. We assessed risk of bias using Newcastle-Ottawa Quality Assessment Scale. We pooled odds ratios (OR) and standardized mean differences (SMD) using random-effect models for primary and secondary outcome, respectively. RESULTS In the qualitative synthesis, 28 studies examining 7595 patients were included. The pooled analysis of 18 studies showed that dippers had a 51% [OR 0.49(0.35-0.69)] lower risk of abnormal cognitive function and a 63% [OR 0.37(0.23-0.61)] lower risk of dementia alone, compared to non-dippers. Reverse dippers presented an up to sixfold higher risk [OR 6.06(3.15-11.64)] of abnormal cognitive function compared to dippers and an almost twofold higher risk [OR 1.81(1.26-2.6)] compared to non-dippers. Reverse dippers performed worse in global function neuropsychological tests compared with both dippers [SMD - 0.66(- 0.93 to - 0.39)] and non-dippers [SMD - 0.35(- 0.53 to - 0.16)]. CONCLUSION Dysregulation of the normal circadian BP rhythm, specifically non-dipping and reverse dipping is associated with abnormal cognitive function. Further studies are required to determine potential underlying mechanisms and possible prognostic or therapeutic implications. PROTOCOL REGISTRATION PROSPERO database (ID: CRD42022310384).
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Affiliation(s)
- Maria Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Konstantinos Mastrogiannis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Eleni Gavriilaki
- Hematology Department, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Antonios Lazaridis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Vasilios Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece.
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5
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Tan X, Sundström J, Lind L, Franzon K, Kilander L, Benedict C. Reverse Dipping of Systolic Blood Pressure Is Associated With Increased Dementia Risk in Older Men. Hypertension 2021; 77:1383-1390. [DOI: 10.1161/hypertensionaha.120.16711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A lower day-to-night systolic blood pressure (BP) dip has previously been associated with poor brain health and cognitive functions. Here, we sought to examine whether reduced (nighttime/daytime ratio of systolic BP >0.9 and ≤1) and reverse (nighttime/daytime ratio of systolic BP >1) dipping of systolic BP is associated with the prospective risk of being diagnosed with any dementia in Swedish older men. Twenty-four-hour ambulatory BP monitoring was used to estimate the nocturnal systolic BP dipping status of men at mean age 71 (n=997; 35% on antihypertensive medication) and 77.6 (n=611; 41% on antihypertensive medication). Dementia incidence during the observational period up to 24 years (n=286 cases) was determined by reviewing participants’ medical history and independently confirmed by at least 2 experienced geriatricians. Using time-updated Cox regression (ie, time-updated information on covariates and exposure), we found that reverse systolic BP dipping was associated with a higher risk of being diagnosed with any dementia (adjusted HR, 1.64 [95% CI, 1.14–2.34],
P
=0.007) and Alzheimer’s disease (1.67 [1.01–2.76],
P
=0.047) but not vascular dementia (1.29 [0.55–3.06],
P
=0.559). In contrast, reduced dipping of nocturnal systolic BP was not associated with a higher risk of being diagnosed with dementia. Our findings suggest that reverse systolic BP dipping may represent an independent risk factor for dementia and Alzheimer’s disease in older men. Future studies should decipher whether therapies lowering nocturnal systolic BP below daytime levels, such as bedtime dosing of antihypertensive medication, can meaningfully curb the development of dementia.
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Affiliation(s)
- Xiao Tan
- Department of Neuroscience (X.T., C.B.), Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden (X.T.)
| | - Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology (J.S.), Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology (L.L.), Uppsala University, Sweden
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Geriatrics (K.F., L.K.), Uppsala University, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics (K.F., L.K.), Uppsala University, Sweden
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6
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Marciante AB, Shell B, Farmer GE, Cunningham JT. Role of angiotensin II in chronic intermittent hypoxia-induced hypertension and cognitive decline. Am J Physiol Regul Integr Comp Physiol 2021; 320:R519-R525. [PMID: 33595364 PMCID: PMC8238144 DOI: 10.1152/ajpregu.00222.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 02/03/2023]
Abstract
Sleep apnea is characterized by momentary interruptions in normal respiration and leads to periods of decreased oxygen, or intermittent hypoxia. Chronic intermittent hypoxia is a model of the hypoxemia associated with sleep apnea and results in a sustained hypertension that is maintained during normoxia. Adaptations of the carotid body and activation of the renin-angiotensin system may contribute to the development of hypertension associated with chronic intermittent hypoxia. The subsequent activation of the brain renin-angiotensin system may produce changes in sympathetic regulatory neural networks that support the maintenance of the hypertension associated with intermittent hypoxia. Hypertension and sleep apnea not only increase risk for cardiovascular disease but are also risk factors for cognitive decline and Alzheimer's disease. Activation of the angiotensin system could be a common mechanism that links these disorders.
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Affiliation(s)
- Alexandria B Marciante
- Breathing REsearch And THErapeutics (BREATHE) Center, University of Florida, Gainesville, Florida
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Brent Shell
- Zuckerberg College of Health Sciences, University of Massachusetts-Lowell, Lowell, Massachusetts
- Department of Biomedical and Nutritional Sciences, University of Massachusetts-Lowell, Lowell, Massachusetts
| | - George E Farmer
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - J Thomas Cunningham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
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7
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Ghazi L, Yaffe K, Tamura MK, Rahman M, Hsu CY, Anderson AH, Cohen JB, Fischer MJ, Miller ER, Navaneethan SD, He J, Weir MR, Townsend RR, Cohen DL, Feldman HI, Drawz PE. Association of 24-Hour Ambulatory Blood Pressure Patterns with Cognitive Function and Physical Functioning in CKD. Clin J Am Soc Nephrol 2020; 15:455-464. [PMID: 32217634 PMCID: PMC7133123 DOI: 10.2215/cjn.10570919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/14/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysis-dependent CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Ambulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65-79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0-12) indicating better functioning; and (3) frailty, measured by meeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes. RESULTS Mean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB score was 9 (interquartile range, 7-10). At baseline, participants with masked hypertension had 0.41 (95% CI, -0.78 to -0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment. CONCLUSIONS In patients with CKD, dipping and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty.
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Affiliation(s)
- Lama Ghazi
- Department of Epidemiology and Community Health, Division of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Kristine Yaffe
- Departments of Epidemiology and Biostatistics and Psychiatry and Neurology, University of California, San Francisco, San Francisco, California
| | - Manjula K Tamura
- Veterans Affairs Palo Alto Health Care System, Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California.,Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Mahboob Rahman
- Division of Nephrology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, California.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Amanda H Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jordana B Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Fischer
- Renal Section and Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois.,Nephrology Division, Department of Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Edgar R Miller
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Feldman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul E Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
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8
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Mansukhani MP, Kolla BP, Somers VK. Hypertension and Cognitive Decline: Implications of Obstructive Sleep Apnea. Front Cardiovasc Med 2019; 6:96. [PMID: 31355211 PMCID: PMC6636426 DOI: 10.3389/fcvm.2019.00096] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/25/2019] [Indexed: 12/16/2022] Open
Abstract
Hypertension and dementia are highly prevalent in the general population. Hypertension has been shown to be a risk factor for Alzheimer's dementia and vascular dementia. Sleep apnea, another common disorder, is strongly associated with hypertension and recent evidence suggests that it may also be linked with cognitive decline and dementia. It is possible that sleep apnea is the final common pathway linking hypertension to the development of dementia. This hypothesis merits further exploration as sleep apnea is readily treatable and such therapy could foreseeably delay or prevent the onset of dementia. At present, there is a paucity of therapeutic modalities that can prevent or arrest cognitive decline. In this review, we describe the associations between hypertension, dementia and sleep apnea, the pathophysiologic mechanisms underlying these associations, and the literature examining the impact of treatment of hypertension and sleep apnea on cognition. Potential areas of future investigation that may help advance our understanding of the magnitude and direction of the interaction between these conditions and the effects of treatment of high blood pressure and sleep apnea on cognition are highlighted.
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Affiliation(s)
| | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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9
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Boa Sorte Silva NC, Gregory MA, Gill DP, McGowan CL, Petrella RJ. The Impact of Blood Pressure Dipping Status on Cognition, Mobility, and Cardiovascular Health in Older Adults Following an Exercise Program. Gerontol Geriatr Med 2018; 4:2333721418770333. [PMID: 29761133 PMCID: PMC5946337 DOI: 10.1177/2333721418770333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/21/2018] [Accepted: 03/13/2018] [Indexed: 01/04/2023] Open
Abstract
Objectives: To determine whether a dual-task gait and aerobic
exercise intervention differentially impacted older adults with normal blood
pressure (BP) dipping status (dippers) compared to those with nondipping status
(nondippers). Methods: This study was a secondary analysis
involving participants (mean age = 70.3 years, 61% women) who attended a
laboratory-based exercise intervention over a 6-month period (40 min/day and 3
days/week). Participants were assessed in measures of cognition, mobility, and
cardiovascular health at baseline, 3, 6, and 12 months (after a 6-month
no-contact follow-up). Results: We observed improvements in
cognition in both groups at 6 and 12 months, although no between-group
differences were seen. Nondippers demonstrated superior improvements in usual
gait velocity and step length after the exercise intervention compared to
dippers. Dippers reduced daytime systolic BP at 6 and 12 months to a greater
extent than nondippers. Discussion: BP dipping status at baseline
did not influence exercise benefits to cognition but did mediate changes in
mobility and cardiovascular health.
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Affiliation(s)
- Narlon C Boa Sorte Silva
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Michael A Gregory
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,University of Montreal, Québec, Canada
| | - Dawn P Gill
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | | | - Robert J Petrella
- Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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10
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Walker KA, Power MC, Gottesman RF. Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review. Curr Hypertens Rep 2017; 19:24. [PMID: 28299725 DOI: 10.1007/s11906-017-0724-3] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertension is a highly prevalent condition which has been established as a risk factor for cardiovascular and cerebrovascular disease. Although the understanding of the relationship between cardiocirculatory dysfunction and brain health has improved significantly over the last several decades, it is still unclear whether hypertension constitutes a potentially treatable risk factor for cognitive decline and dementia. While it is clear that hypertension can affect brain structure and function, recent findings suggest that the associations between blood pressure and brain health are complex and, in many cases, dependent on factors such as age, hypertension chronicity, and antihypertensive medication use. Whereas large epidemiological studies have demonstrated a consistent association between high midlife BP and late-life cognitive decline and incident dementia, associations between late-life blood pressure and cognition have been less consistent. Recent evidence suggests that hypertension may promote alterations in brain structure and function through a process of cerebral vessel remodeling, which can lead to disruptions in cerebral autoregulation, reductions in cerebral perfusion, and limit the brain's ability to clear potentially harmful proteins such as β-amyloid. The purpose of the current review is to synthesize recent findings from epidemiological, neuroimaging, physiological, genetic, and translational research to provide an overview of what is currently known about the association between blood pressure and cognitive function across the lifespan. In doing so, the current review also discusses the results of recent randomized controlled trials of antihypertensive therapy to reduce cognitive decline, highlights several methodological limitations, and provides recommendations for future clinical trial design.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA. .,Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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11
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Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases 2017; 5:82-92. [PMID: 28352632 PMCID: PMC5352963 DOI: 10.12998/wjcc.v5.i3.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/13/2016] [Accepted: 12/01/2016] [Indexed: 02/05/2023] Open
Abstract
There is arguably no less understood or more intriguing problem in hypertension that the "white coat" condition, the standard concept of which is significantly blood pressure reading obtained by medical personnel of authoritative standing than that obtained by more junior and less authoritative personnel and by the patients themselves. Using hospital-initiated ambulatory blood pressure monitoring, the while effect manifests as initial and ending pressure elevations, and, in treated patients, a low daytime profile. The effect is essentially systolic. Pure diastolic white coat hypertension appears to be exceedingly rare. On the basis of the studies, we believe that the white coat phenomenon is a common, periodic, neuro-endocrine reflex conditioned by anticipation of having the blood pressure taken and the fear of what this measurement may indicate concerning future illness. It does not change with time, or with prolonged association with the physician, particularly with advancing years, it may be superimposed upon essential hypertension, and in patients receiving hypertensive medication, blunting of the nighttime dip, which occurs in about half the patients, may be a compensatory mechanisms, rather than an indication of cardiovascular risk. Rather than the blunted dip, the morning surge or the widened pulse pressure, cardiovascular risk appears to be related to elevation of the average night time pressure.
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12
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Conway KS, Forbang N, Beben T, Criqui MH, Ix JH, Rifkin DE. Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study. Am J Hypertens 2015; 28:1444-52. [PMID: 25896923 DOI: 10.1093/ajh/hpv042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/15/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Twenty-four-hour ambulatory blood pressure (BP) patterns have been associated with diminished cognitive function in hypertensive and very elderly populations. The relationship between ambulatory BP patterns and cognitive function in community-living older adults is unknown. METHODS We conducted a cross-sectional study in which 24-hour ambulatory BP, in-clinic BP, and cognitive function measures were obtained from 319 community-living older adults. RESULTS The mean age was 72 years, 66% were female, and 13% were African-American. We performed linear regression with performance on the Montreal Cognitive Assessment (MoCA) as the primary outcome and 24-hour BP patterns as the independent variable, adjusting for age, sex, race/ethnicity, education, and comorbidities. Greater nighttime systolic dipping (P = 0.046) and higher 24-hour diastolic BP (DBP; P = 0.015) were both significantly associated with better cognitive function, whereas 24-hour systolic BP (SBP), average real variability, and ambulatory arterial stiffness were not. CONCLUSIONS Higher 24-hour DBP and greater nighttime systolic dipping were significantly associated with improved cognitive function. Future studies should examine whether low 24-hour DBP and lack of nighttime systolic dipping predict future cognitive impairment.
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Affiliation(s)
- Kyle S Conway
- Divisions of Nephrology, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Nketi Forbang
- Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Tomasz Beben
- Divisions of Nephrology, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Michael H Criqui
- Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Joachim H Ix
- Divisions of Nephrology, University of California, San Diego School of Medicine, San Diego, California, USA; Veterans' Affairs Healthcare System, San Diego, California, USA
| | - Dena E Rifkin
- Divisions of Nephrology, University of California, San Diego School of Medicine, San Diego, California, USA; Veterans' Affairs Healthcare System, San Diego, California, USA.
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Tarumi T, Harris TS, Hill C, German Z, Riley J, Turner M, Womack KB, Kerwin DR, Monson NL, Stowe AM, Mathews D, Cullum CM, Zhang R. Amyloid burden and sleep blood pressure in amnestic mild cognitive impairment. Neurology 2015; 85:1922-9. [PMID: 26537049 DOI: 10.1212/wnl.0000000000002167] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/25/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine whether cortical β-amyloid (Aβ) deposition is associated with circadian blood pressure (BP) profiles and dynamic cerebral blood flow (CBF) regulation in patients with amnestic mild cognitive impairment (aMCI). METHODS Forty participants with aMCI were included in this study. Cortical Aβ depositions were measured by (18)F-florbetapir PET and expressed as the standardized uptake value ratio (SUVR) relative to the cerebellum. Circadian BP profiles were measured by 24-hour ambulatory monitoring during awake and sleep periods. The dipping status of sleep BP (i.e., the percent changes from the awake BP) was calculated and dichotomized into the dipper (≥10%) and nondipper (<10%) groups. Dynamic CBF regulation was assessed by a transfer function analysis between beat-to-beat changes in BP and CBF velocity measured from the middle cerebral artery during a repeated sit-stand maneuver. RESULTS Age was positively correlated with a greater Aβ deposition in the posterior cingulate, precuneus, and mean cortex. Accounting for the age effect, attenuated reductions in sleep systolic BP were associated with higher levels of posterior cingulate SUVR. Consistently, the nondippers exhibited a higher SUVR in the posterior cingulate than the dippers. Transfer function gain between changes in BP and CBF velocity was diminished in the nondippers, and moreover those individuals with a lower gain exhibited a higher SUVR in the posterior cingulate. CONCLUSIONS Attenuated reductions in sleep BP are associated with a greater Aβ burden in the posterior cingulate and altered dynamic CBF regulation in patients with aMCI.
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Affiliation(s)
- Takashi Tarumi
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Thomas S Harris
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Candace Hill
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Zohre German
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Jonathan Riley
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Marcel Turner
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Kyle B Womack
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Diana R Kerwin
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Nancy L Monson
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Ann M Stowe
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Dana Mathews
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - C Munro Cullum
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas
| | - Rong Zhang
- From the Institute for Exercise and Environmental Medicine (T.T., C.H., J.R., M.T., R.Z.) and Texas Alzheimer's and Memory Disorders (D.R.K.), Texas Health Presbyterian Hospital Dallas; and the Departments of Internal Medicine (T.T., R.Z.), Neurology and Neurotherapeutics (T.S.H., Z.G., K.B.W., N.L.M., A.M.S., D.M., C.M.C., R.Z.), Psychiatry (K.B.W., C.M.C.), and Radiology (D.M.), University of Texas Southwestern Medical Center, Dallas.
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14
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Blood pressure variability predicts cognitive decline in Alzheimer's disease patients. Neurobiol Aging 2014; 35:2282-7. [PMID: 24856056 DOI: 10.1016/j.neurobiolaging.2014.04.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/24/2014] [Accepted: 04/22/2014] [Indexed: 12/12/2022]
Abstract
The aim of our study was to evaluate whether blood pressure variability influences the rate of cognitive decline in Alzheimer's disease (AD). Two hundred and forty AD patients were periodically evaluated for a 12-month period. The blood pressure (BP) status of each patient was defined through mean and coefficient of variation for both systolic and diastolic BP. Progression of cognitive decline was investigated using the Mini Mental State Examination administered at entry and at the end of follow-up. Among the considered BP indices, only systolic BP variability explained the decrease in the Mini Mental State Examination score after adjustment for confounding variables (multiple linear regression: R(2) = 0.603, adjusted R(2) = 0.513; p < 0.001; logistic regression model: odds ratio = 2.882, 95% confidence interval = 1.772-4.495; p < 0.001). The receiver operating characteristic analysis for evaluating the ability of systolic BP variability to predict a faster cognitive decline presented an area under the curve of 0.913 (95% confidence interval = 0.874-0.953; p < 0.001). Our results suggest that BP variability may be added to the list of the potential vascular risk factors and included in the evaluation of AD patients to better define their risk profile.
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15
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Abstract
We have reviewed the most relevant data regarding ABPM and brain damage, with specific reference to first and recurrent stroke, silent structural brain lesions such as lacunar infarcts and white matter lesions, and cognitive impairment. Only two large studies have evaluated the usefulness of ABPM in relation to antihypertensive treatment in primary stroke prevention. In the Syst-Eur trial, drug treatment reduced ABPM and office BP more than placebo in patients with sustained isolated systolic hypertension (ISH). In contrast, in those patients with white-coat hypertension (WCH) changes in ABPM between the treatment groups were not significantly different. Patients with WCH had a lower incidence of stroke (p < 0.05) during follow-up than patients with sustained ISH, suggesting that WCH is a benign condition. In the HYVET trial 50 % of the very elderly patients included with office systolic BP > 160 mmHg had WCH. However, a significant 30 % stroke reduction was observed in treated patients including those with WCH, indicating that WCH may not be a benign condition in the elderly. In the acute stroke setting, where treatment of hypertension is not routinely recommended due to the lack of evidence and the differing results of the very few available trials, ABPM data shows that sustained high BP during the first 24 h after acute stroke is related to the formation of cerebral edema and a poorer functional status. On the other hand, even when nondipping status was initially related to a poorer prognosis, data indicate that patients with very-large nocturnal dipping, the so-called "extreme dippers", are those with the worse outcomes after stroke. The association between different ABPM parameters (circadian pattern, short-term variability) and poorer performance scores in cognitive function tests have been reported, especially in elderly hypertensives. Unfortunately most of these studies were cross-sectional and the associations do not establish causality.
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16
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Onen SH, Lesourd B, Ouchchane L, Lin JS, Dubray C, Gooneratne NS, Onen F. Occult Nighttime Hypertension in Daytime Normotensive Older Patients With Obstructive Sleep Apnea. J Am Med Dir Assoc 2012; 13:752-6. [DOI: 10.1016/j.jamda.2012.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 11/25/2022]
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17
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O'Brien E. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med 2011; 269:478-95. [PMID: 21281363 DOI: 10.1111/j.1365-2796.2011.02356.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review presents evidence that ambulatory blood pressure measurement (ABPM) should be used more widely in clinical practice and hypertension research. The technique, which should be mandatory in trials of antihypertensive drugs, is not being used in all studies of antihypertensive drug efficacy. ABPM is also being under-used in outcome studies. The failure to implement ABPM in primary care and hypertension research is impeding patient management and scientific advancement. ABPM offers so many advantages in assessing the efficacy of blood pressure (BP)-lowering drugs that it should be mandatory in pharmacological trials. Likewise, the technique provides a means of achieving BP control in clinical practice, which is essential if we are to halt the epidemic of the cardiovascular consequences of hypertension. However, if ABPM is to be implemented for these purposes, certain requirements will need to be fulfilled. These include the availability of accurate, patient-friendly and inexpensive devices; standardization of the presentation and plotting of data with summary statistics for day-to-day practice; provision of comprehensive data analysis for research; an interpretative report to facilitate use in busy clinical practice; a trend report to demonstrate efficacy or otherwise of treatment in clinical practice and online transmission of data to provide immediate real-time data analysis. The reasons why ABPM is not being implemented are reviewed, and proposals are made to make the technique more acceptable.
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Affiliation(s)
- E O'Brien
- Department of Molecular Pharmacology, The Conway Institute, University College Dublin, Dublin, Ireland
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18
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Beauchet O, Herrmann FR, Annweiler C, Kerlerouch J, Gosse P, Pichot V, Celle S, Roche F, Barthelemy J. Association Between Ambulatory 24-Hour Blood Pressure Levels and Cognitive Performance: A Cross-Sectional Elderly Population-Based Study. Rejuvenation Res 2010; 13:39-46. [DOI: 10.1089/rej.2009.0878] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Oliver Beauchet
- Department of Internal Medicine and Geriatrics, Angers University Hospital; Angers University Memory Center, University of Angers, Angers, France
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics & Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cédric Annweiler
- Department of Internal Medicine and Geriatrics, Angers University Hospital; Angers University Memory Center, University of Angers, Angers, France
| | - Judith Kerlerouch
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne; Faculté de Médecine J. Lisfranc; PRES de Lyon 42022; Université Jean Monnet, Saint Etienne, France
| | - Philippe Gosse
- Saint André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Vincent Pichot
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne; Faculté de Médecine J. Lisfranc; PRES de Lyon 42022; Université Jean Monnet, Saint Etienne, France
| | - Sebastien Celle
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne; Faculté de Médecine J. Lisfranc; PRES de Lyon 42022; Université Jean Monnet, Saint Etienne, France
| | - Frederic Roche
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne; Faculté de Médecine J. Lisfranc; PRES de Lyon 42022; Université Jean Monnet, Saint Etienne, France
- Frederic Roche and Jean-Claude Barthelemy are co-senior authors
| | - J.C. Barthelemy
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne; Faculté de Médecine J. Lisfranc; PRES de Lyon 42022; Université Jean Monnet, Saint Etienne, France
- Frederic Roche and Jean-Claude Barthelemy are co-senior authors
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19
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Brown JP, Sollers JJ, Thayer JF, Zonderman AB, Waldstein SR. Blood pressure reactivity and cognitive function in the Baltimore Longitudinal Study of Aging. Health Psychol 2009; 28:641-6. [PMID: 19751091 DOI: 10.1037/a0015215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Several blood pressure indexes of autonomic dysregulation, including stress-induced blood pressure responses (i.e., reactivity), have been associated previously with stroke, silent cerebrovascular disease, and decreased cognitive function. DESIGN The authors examined the cross-sectional relations among systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity and cognitive function in a sample of stroke- and dementia-free older adults (n = 73, 53% male, 72% Caucasian, mean age = 70.14 years) from the Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASURES Age, education, baseline, and reactive blood pressure levels were regressed on cognitive test scores measuring the domains of attention, learning and memory, verbal functions/language skills, and perceptuo-motor speed. A Bonferroni correction was employed and results significant at the standard p < .05 level are discussed as marginally significant. RESULTS After adjustment for age, education, and resting blood pressure, greater SBP reactivity was associated with poorer performance on Digits Forward (R2 = .110, p = .007) and greater DBP reactivity was associated with poorer performance on Digits Forward (R(2) = .124, p = .003) and the Boston Naming Test (R(2) = .118, p = .008); associations with DBP reactivity and Alpha Span (R(2) = .104; p = .019) and CVLT free recall short delay (R(2) = .066, p = .032) were marginally significant. CONCLUSIONS Greater BP reactivity was associated with poorer performance on tests of attention, verbal memory, and confrontation naming. BP reactivity may be a biobehavioral risk factor for lowered levels of cognitive performance.
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Affiliation(s)
- Jessica P Brown
- Department of Epidemiology & Preventive Medicine, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
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20
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The structural and functional consequences of diurnal variations in blood pressure in treated patients with hypertensive cerebrovascular disease. J Hypertens 2009; 27:1042-8. [PMID: 19337131 DOI: 10.1097/hjh.0b013e32832810d5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hypertension is known to cause brain damage and cognitive impairment, epidemiological studies suggest that lower blood pressure (BP) in patients with established cerebrovascular disease is associated with more rapid cognitive decline. We investigated the relationship between 24-h ambulatory blood pressure (ABP) measurements, cerebrovascular disease load and cognitive performance in patients with hypertensive cerebrovascular disease. METHODS Eighty-eight patients (mean age 65+9 years) with hypertensive cerebrovascular disease on MRI were recruited. BP was controlled optimally. ABP monitoring, quantitative MRI analysis of white matter lesion (WML) volume and executive cognitive function tests were performed. The relationships between ABP variables, WML volume and executive test performance were examined using regression analyses to adjust for age, sex, vascular risk profile and premorbid intelligence. RESULTS Patients had a mean daytime ABP of 96+10 mmHg and mean night-time ABP of 88+11 mmHg (P = 0.001). Median WML volume was 8464 mm3. There were no significant associations between ABP variables and supratentorial WML volumes. Infratentorial WML volume correlated negatively with night-time mean BP (r = -0.6, P = 0.002) and positively with nocturnal dipping (r = 0.6, P = 0.002). Higher night-time mean BP was an independent predictor of reduced infratentorial WML volume (R2: 0.460, P = 0.008).Infratentorial WML volume correlated with impairments of phonemic verbal fluency (r = 0.5, P < 0.001) and choice reaction time (r = 0.7, P < 0.005). CONCLUSION Physiological falls in nocturnal BP may be associated with increased infratentorial WML volume and cognitive dysfunction in optimally controlled hypertensive patients with cerebrovascular disease.
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21
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Low ambulatory blood pressure is associated with lower cognitive function in healthy elderly men. Blood Press Monit 2008; 13:269-75. [PMID: 18799952 DOI: 10.1097/mbp.0b013e32830d4be6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however. METHODS Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors. RESULTS Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.). CONCLUSION Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age.
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Axelsson J, Reinprecht F, Siennicki-Lantz A, Elmståhl S. Lower cognitive performance in 81-year-old men with greater nocturnal blood pressure dipping. Int J Gen Med 2008; 1:69-75. [PMID: 20428409 PMCID: PMC2840544 DOI: 10.2147/ijgm.s4287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abnormal day-to-night blood pressure (BP) pattern have been found to be associated with cerebrovascular damage, yet studies of the elderly 80 years of age and above, for whom the risk pattern may be different due to ageing and age-associated diseases, are lacking. Ninety-seven 81-year-old men underwent ambulatory BP monitoring and were given six cognitive tests, 79 of the men completing the cognitive test battery. The odds ratio (OR) for performing one standard deviation below the mean on any cognitive test was calculated using a forward stepwise logistic regression model, confounding factors being controlled for. Groups defined in terms of day-to-night changes in BP were compared in this respect. Cognitive performance was lower (OR 3.6; P = 0.017) in the group usually described as dippers (10%–20% nocturnal drop in systolic BP [SBP]) as compared with nondippers (<10% drop). The tertile with the greatest SBP fall (10.6%–19.8%, a range considered as normal among middle aged) showed lowest cognitive performance (OR 4.7; P = 0.008) as compared with the middle tertile (5.1%–10.5% drop). The mean nocturnal fall in SBP was 7.4%, significantly greater in those with lower rather than higher cognitive performance. A nocturnal drop in SBP of ≥10% was associated with lower cognitive performance in these elderly men. The limits to normal dipping appear to be shifted in the direction of a lesser drop in the very elderly.
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Affiliation(s)
- Johan Axelsson
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Malmö University Hospital, Malmö, Sweden
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O'Brien E. The circadian nuances of hypertension: a reappraisal of 24-h ambulatory blood pressure measurement in clinical practice. Ir J Med Sci 2007; 176:55-63; discussion 65-6. [PMID: 17453322 DOI: 10.1007/s11845-007-0022-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
Ambulatory blood pressure measurement has been in use in clinical practice for nearly half a century. However, despite the benefits the technique brings to managing patients with hypertension it is much under-used in practice. The purpose of this review is to examine critically the information that can be derived from the technique and to highlight the application of this evidence in clinical practice.
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Affiliation(s)
- E O'Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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24
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Grigg-Damberger M. Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack. J Clin Neurophysiol 2006; 23:21-38. [PMID: 16514349 DOI: 10.1097/01.wnp.0000201077.44102.80] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neurologists need to recognize, diagnose, and treat obstructive sleep apnea (OSA) in patients with stroke or transient ischemic attack (TIA). Increasing medical evidence suggests that OSA is an independent risk factor for stroke and TIA. Stroke (or TIA) is more likely a cause, rather than a consequence, of OSA because PSG studies have shown: 1) apneas in stroke are typically obstructive, not central or Cheyne-Stokes in type; 2) apneas are just as frequent and severe in patients with either TIA or stroke; 3) OSA severity is not influenced by the acuteness or location of the stroke; 4) untreated OSA patients have more strokes, stroke morbidity, and mortality than those who are treated. OSA alone can induce hypertension, especially in younger men. A causal relationship has recently been demonstrated between OSA and hypertension. A distinctive feature of OSA-induced hypertension is loss of the normal nighttime fall in blood pressure ("nondippers"). Data from the Sleep Heart Health Study showed a dose-response association between OSA severity and the presence of hypertension 4 years later. Hypertension or ischemic heart disease usually develops in untreated patients with OSA over time without particular worsening of OSA. Studies have shown sleep itself is not a risk factor for stroke because most stroke and TIAs begin between 6 am and noon, while the individual is awake. However, OSA promptly be considered in stroke beginning during sleep because 88% of strokes that develop during sleep occur in "nondippers." Premature death in OSA patients is most often cardiovascular, but occurs while the patients are awake. The risk of myocardial infarction is increased 20-fold in untreated OSA. Treating OSA patients with continuous positive airway pressure can prevent or improve hypertension, reduce abnormal elevations of inflammatory cytokines and adhesion molecules, reduce excessive sympathetic tone, avoid increased vascular oxidative stress, reverse coagulation abnormalities, and reduce leptin levels. If all this can be achieved by a polysomnogram, then this test should become part of a neurologist's armamentarium for stroke and TIA.
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Affiliation(s)
- Madeleine Grigg-Damberger
- Pediatric Sleep Services, University Hospital Sleep Disorders Center, and Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA.
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van Boxtel MPJ, Henskens LHG, Kroon AA, Hofman PAM, Gronenschild EHBM, Jolles J, de Leeuw PW. Ambulatory blood pressure, asymptomatic cerebrovascular damage and cognitive function in essential hypertension. J Hum Hypertens 2006; 20:5-13. [PMID: 16163365 DOI: 10.1038/sj.jhh.1001934] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Prolonged exposure to elevated blood pressure (BP) can lead to both structural (white matter lesions (WML) or infarctions) and functional changes in the brain. We studied in previously diagnosed essential hypertensive individuals if diurnal BP variation and ambulatory BP (ABP) profile (daytime, night time and 24-h BP averages) were related to evidence of WML, the presence of 'silent' infarcts, and cognitive performance. A group of 86 patients (mean age 57.4+/-10 years, range 40-80) were first screened for hypertension-related organ damage and underwent 24-h ABP monitoring, magnetic resonance imaging (MRI) of the brain, and a comprehensive neurocognitive assessment. Age and ABP profile were related to more periventricular, but not subcortical, WML and to presence of lacunar infarctions on MRI. After correction for demographical group differences, no association was found between night time dipping of BP on the one hand and both WML load and cognitive parameters (verbal memory, sensorimotor speed, cognitive flexibility) on the other. The presence of lacunar infarctions, however, predicted lower performance on verbal memory. Furthermore, daytime and 24-h pulse pressure averages were associated with pWML, whereas systolic BP and mean arterial pressure (MAP) for daytime, night-time and 24-h periods were higher in patients with lacunar infarctions. Notwithstanding the large variability of WML in this sample, the evidence of a connection between diurnal BP variation and early target organ damage in the brain was not convincing. However, the ABP profile may be predictive of cerebral lesion type.
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Affiliation(s)
- M P J van Boxtel
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
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