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Lutchman Y, Mahajan R, Cosh SM, Harris K, Tzourio C, Tully PJ. Under pressure: A systematic review of the association between blood pressure variability with depression and anxiety. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100228. [PMID: 38974909 PMCID: PMC11225212 DOI: 10.1016/j.cccb.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/05/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024]
Abstract
Blood pressure variability (BPV) impacts brain health by influencing brain structure and cerebrovascular pathologies, though the mechanisms are poorly understood. Changes in the cerebrovasculature may lead to late-onset depression, cognitive impairment, and dementia, however the relationship between BPV with depression and anxiety remains unclear, due to methodological differences and inconsistencies in past research. This review aims to clarify the association between BPV with depression and anxiety in adults to inform understandings of the mechanisms implicating BPV in cognitive health. A systematic search from inception through to January 2024 was performed on Embase, PubMed, PsycINFO, and Web of Science. Studies that assessed BPV quantified by beat-to-beat, 24-hour, or visit-to-visit were eligible if the standardised assessment of depression and/or anxiety were reported as a linear association, or mean differences across control and affect groups. A total of 14 articles reporting on 13 samples and N = 5055 persons met the inclusion criteria (median female proportion = 61 %, range 0 % - 76 %). A meta-analysis was not possible due to methodological heterogeneity in BPV measurements and metrics across studies. Mixed results were observed across depression studies with inconsistencies and variation in the direction, strength of association, and BPV metric. There was weak evidence from only three studies to support a linear association between systolic coefficient of variation and anxiety. Collectively, the findings contribute to understanding the association between BPV and brain health, suggesting that any relationship between BPV and brain structures critical for cognitive function are independent of depression and only modestly implicate anxiety.
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Affiliation(s)
- Yuvthi Lutchman
- School of Psychology, The University of New England, Australia
| | - Rajiv Mahajan
- Adelaide Medical School, The University of Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, The University of New England, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, F-33000 Bordeaux, France
| | - Phillip J. Tully
- School of Psychology, The University of New England, Australia
- School of Medicine, The University of Adelaide, Australia
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Sible IJ, Jang JY, Blanken AE, Alitin JPM, Engstrom A, Dutt S, Marshall AJ, Kapoor A, Shenasa F, Gaubert A, Nguyen A, Ferrer F, Bradford DR, Rodgers KE, Mather M, Duke Han S, Nation DA. Short-term blood pressure variability and brain functional network connectivity in older adults. NEUROIMAGE. REPORTS 2024; 4:100198. [PMID: 38699510 PMCID: PMC11064972 DOI: 10.1016/j.ynirp.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Blood pressure variability is increasingly linked with cerebrovascular disease and Alzheimer's disease, independent of mean blood pressure levels. Elevated blood pressure variability is also associated with attenuated cerebrovascular reactivity, which may have implications for functional hyperemia underpinning brain network connectivity. It remains unclear whether blood pressure variability is related to functional network connectivity. We examined relationships between beat-to-beat blood pressure variability and functional connectivity in brain networks vulnerable to aging and Alzheimer's disease. Methods 53 community-dwelling older adults (mean [SD] age = 69.9 [7.5] years, 62.3% female) without history of dementia or clinical stroke underwent continuous blood pressure monitoring and resting state fMRI scan. Blood pressure variability was calculated as variability independent of mean. Functional connectivity was determined by resting state fMRI for several brain networks: default, salience, dorsal attention, fronto-parietal, and language. Multiple linear regression examined relationships between short-term blood pressure variability and functional network connectivity. Results Elevated short-term blood pressure variability was associated with lower functional connectivity in the default network (systolic: standardized ß = -0.30 [95% CI -0.59, -0.01], p = .04). There were no significant associations between blood pressure variability and connectivity in other functional networks or between mean blood pressure and functional connectivity in any network. Discussion Older adults with elevated short-term blood pressure variability exhibit lower resting state functional connectivity in the default network. Findings support the role of blood pressure variability in neurovascular dysfunction and Alzheimer's disease. Blood pressure variability may represent an understudied early vascular risk factor for neurovascular dysfunction relevant to Alzheimer's disease, with potential therapeutic implications.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jung Yun Jang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA 92697, USA
| | - Anna E. Blanken
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94158, USA
| | - John Paul M. Alitin
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Allie Engstrom
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Shubir Dutt
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94158, USA
| | - Anisa J. Marshall
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Arunima Kapoor
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Fatemah Shenasa
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Aimée Gaubert
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Amy Nguyen
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Farrah Ferrer
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - David R. Bradford
- Center for Innovation in Brain Science, Department of Pharmacology, The University of Arizona, Tucson, AZ, 85721, USA
| | - Kathleen E. Rodgers
- Center for Innovation in Brain Science, Department of Pharmacology, The University of Arizona, Tucson, AZ, 85721, USA
| | - Mara Mather
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - S. Duke Han
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Department of Family Medicine, Keck School of Medicine of University of Southern California, Alhambra, CA 91803, USA
| | - Daniel A. Nation
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
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Sible IJ, Nation DA. Blood Pressure Variability and Plasma Alzheimer's Disease Biomarkers in the SPRINT Trial. J Alzheimers Dis 2024; 97:1851-1860. [PMID: 38306042 DOI: 10.3233/jad-230930] [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] [Indexed: 02/03/2024]
Abstract
Background Recent observational studies suggest higher blood pressure (BP) variability (BPV) is associated with Alzheimer's disease (AD) biomarkers amyloid-beta (Aβ) and tau. Less is known about relationships in interventional cohorts with strictly controlled mean BP levels. Objective Investigate the longitudinal relationship between BPV and change in plasma AD biomarkers under standard versus intensive BP treatment. Methods In this post hoc analysis of the SPRINT trial, 457 participants (n = 206 in standard group, n = 251 in intensive group) underwent repeated BP measurement between baseline and 12-months follow-up, and venipuncture at baseline and median (IQR) 3.5 (3.0-4.0) years later to determine plasma AD biomarkers total tau and Aβ1-42:Aβ1-40 ratio. BPV was calculated as tertiles of variability independent of mean. Linear mixed models investigated the effect of BPV×time on AD biomarker levels. Results Higher BPV was associated with increased levels of total tau in the standard group (β [95% CI] 1st versus 3rd tertiles of BPV: 0.21 [0.02, 0.41], p = 0.035), but not in the intensive group (β [95% CI] 1st versus 3rd tertiles of BPV: -0.02 [-0.19, 0.16], p = 0.843). BPV was not associated with Aβ 1-42:Aβ 1-40 ratio in either group. Mean BP was not associated with biomarkers. Conclusions Higher BPV was associated with increased plasma total tau under standard BP treatment. Findings add new evidence to prior observational work linking BPV to AD pathophysiology and suggest that, despite strict control of mean BP, BPV remains a risk for pathophysiological change underlying risk for AD.
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Affiliation(s)
- Isabel J Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA
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Lattanzi S, Słomka A, Divani AA. Blood Pressure Variability and Cerebrovascular Reactivity. Am J Hypertens 2023; 36:19-20. [PMID: 36219582 DOI: 10.1093/ajh/hpac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Toruń, Poland
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
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Abstract
BACKGROUND Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures. METHODS AND RESULTS The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume. CONCLUSION Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.
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Lee ATC, Fung AWT, Richards M, Chan WC, Chiu HFK, Lee RSY, Lam LCW. Late-life longitudinal blood pressure trajectories as predictor of dementia. Sci Rep 2022; 12:1630. [PMID: 35102219 PMCID: PMC8803958 DOI: 10.1038/s41598-022-05680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 11/08/2022] Open
Abstract
While hypertension is widely recognized as a risk factor for dementia, few observational studies and clinical trials fully accounted for the effect of age on blood pressure (BP) changes prior to dementia onset. In this territory-wide population-based longitudinal study of 16,591 community-living dementia-free older adults, we followed their BP and cognitive status and tested if loss of longitudinal increase in BP in late life was associated with higher dementia risk in 6 years, with consideration of the confounding effects of hypertension, hypotension, BP variability, and other health problems and behaviours and, in the data analysis, exclusion of individuals who developed dementia within 3 years after baseline to minimize risk of reverse causality. Over 72,997 person-years of follow-up, 1429 participants developed dementia. We found that loss of longitudinal increase in systolic BP (defined as SBP increased by either < 10 mmHg or 10%) from baseline to Year 3 was independently associated with higher risk of incident dementia at Years 4 to 6 (adjusted OR 1.22, 95% CI 1.02-1.45, p = 0.03; adjusted OR 1.24, 95% CI 1.03-1.50, p = 0.02; respectively). Our findings suggest that late-life SBP trajectory changes might independently predict dementia onset and highlight the importance of including longitudinal BP monitoring in dementia risk assessment.
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Affiliation(s)
- Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ada W T Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wai C Chan
- Department of Psychiatry, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Helen F K Chiu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong SAR, Hong Kong SAR, China
| | - Linda C W Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Nagai M, Kato M, Dote K. Visit-to-visit blood pressure variability in mild cognitive impairment: A possible marker of Alzheimer's disease in the SPRINT study? J Clin Hypertens (Greenwich) 2021; 23:2129-2132. [PMID: 34806836 PMCID: PMC8696211 DOI: 10.1111/jch.14388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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de Heus RA, Tzourio C, Lee EJL, Opozda M, Vincent AD, Anstey KJ, Hofman A, Kario K, Lattanzi S, Launer LJ, Ma Y, Mahajan R, Mooijaart SP, Nagai M, Peters R, Turnbull D, Yano Y, Claassen JA, Tully PJ. Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis. Hypertension 2021; 78:1478-1489. [PMID: 34538105 PMCID: PMC8516811 DOI: 10.1161/hypertensionaha.121.17797] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Rianne A.A. de Heus
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
| | - Christophe Tzourio
- Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.)
| | - Emily Jo Lynn Lee
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Melissa Opozda
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia
| | - Andrew D. Vincent
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Kaarin J. Anstey
- School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia
| | - Albert Hofman
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.)
| | - Lenore J. Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.)
| | - Yuan Ma
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
| | - Rajiv Mahajan
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
- Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.)
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia
- University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia
- School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.)
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.)
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.)
- Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.)
- Imperial College London, United Kingdom (R.P.)
- Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.)
- The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Simon P. Mooijaart
- University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.)
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.)
| | - Ruth Peters
- Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia
- Imperial College London, United Kingdom (R.P.)
| | - Deborah Turnbull
- School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Yuichiro Yano
- Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.)
- The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Jurgen A.H.R. Claassen
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
| | - Phillip J. Tully
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
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Sible IJ, Bangen KJ, Blanken AE, Ho JK, Nation DA. Antemortem Visit-To-Visit Blood Pressure Variability Predicts Cerebrovascular Lesion Burden in Autopsy-Confirmed Alzheimer's Disease. J Alzheimers Dis 2021; 83:65-75. [PMID: 34250941 DOI: 10.3233/jad-210435] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Blood pressure variability is linked to Alzheimer's disease (AD) risk and MRI-based markers of cerebrovascular disease. Less is known about the role of blood pressure variability in postmortem evaluation of cerebrovascular disease and AD. OBJECTIVE To determine whether antemortem blood pressure variability predicts cerebrovascular and AD pathology and follow-up cognitive change in autopsy-confirmed AD. METHODS National Alzheimer's Coordinating Center participants (n = 513) underwent 3-4 approximately annual blood pressure measurements and were confirmed to have AD at postmortem evaluation. A subset (n = 493) underwent neuropsychological evaluation at follow-up. Regression models examined relationships between blood pressure variability and cerebrovascular and AD pathological features and follow-up cognitive change. RESULTS Elevated blood pressure variability predicted increased postmortem cerebrovascular lesion burden (ß = 0.26 [0.10, 0.42]; p = 0.001; R2 = 0.12). Increased blood pressure variability predicted specific cerebrovascular lesion severity, including atherosclerosis in the Circle of Willis (OR = 1.22 [1.03, 1.44]; p = 0.02) and cerebral arteriolosclerosis (OR = 1.32 [1.04, 1.69]; p = 0.03). No significant relationships were observed between blood pressure variability and AD pathological findings, including Braak & Braak stage, neuritic plaques or diffuse plaques, or cerebral amyloid angiopathy, or follow-up cognitive decline. CONCLUSION Findings suggest that elevated blood pressure variability is related to postmortem cerebrovascular lesion burden in autopsy-confirmed AD, independent of average blood pressure and AD neuropathology. Blood pressure fluctuation may selectively promote atherosclerotic and arteriolosclerotic brain lesions with potential implications for cognitive impairment and dementia.
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Affiliation(s)
- Isabel J Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Katherine J Bangen
- Research Service, Veteran Affairs San Diego Health Care System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Anna E Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jean K Ho
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Daniel A Nation
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA.,Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
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Guimarães Cunha P, Stolarz-Skrzypek K, Persu A. Increased Blood Pressure Variability May Herald Cognitive Decline and Dementia. Hypertension 2020; 76:1076-1078. [DOI: 10.1161/hypertensionaha.120.14785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pedro Guimarães Cunha
- From the Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Guimarães–Hospital Senhora da Oliveira/Minho University, Portugal (P.G.C.)
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho (P.G.C.)
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal (P.G.C.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S.)
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc Université catholique de Louvain, Brussels, Belgium (A.P.)
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium (A.P.)
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11
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Rouch L, Cestac P, Sallerin B, Piccoli M, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Derumeaux G, Falissard B, Forette F, Pasquier F, Pinget M, Ourabah R, Danchin N, Hanon O, Vidal JS. Visit-to-Visit Blood Pressure Variability Is Associated With Cognitive Decline and Incident Dementia: The S.AGES Cohort. Hypertension 2020; 76:1280-1288. [PMID: 32862710 DOI: 10.1161/hypertensionaha.119.14553] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS-Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=-0.12 (0.06), P=0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=-0.20 (0.06), P<0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD (P=0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01-1.50], P=0.04). Similar results were found for diastolic BPV and mean arterial pressure variability (P<0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.
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Affiliation(s)
- Laure Rouch
- From the EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France (L.R., M.P., O.H., J.-S.V.)
| | - Philippe Cestac
- Unité INSERM 1027, Toulouse, France (P.C.).,Université Paul Sabatier, Toulouse, France (P.C., B.S.).,Pôle Pharmacie, Centre Hospitalier Universitaire de Toulouse, France (P.C., B.S.)
| | - Brigitte Sallerin
- Université Paul Sabatier, Toulouse, France (P.C., B.S.).,Pôle Pharmacie, Centre Hospitalier Universitaire de Toulouse, France (P.C., B.S.).,Unité INSERM 1048, Toulouse, France (B.S.)
| | - Matthieu Piccoli
- From the EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France (L.R., M.P., O.H., J.-S.V.)
| | | | | | - Gilles Berrut
- CHU Nantes, Pôle de soins gériatriques, France (G.B.)
| | - Emmanuelle Corruble
- INSERM U669 (E.C.), Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.,Service de Psychiatrie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France (E.C.)
| | - Geneviève Derumeaux
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France (G.D.)
| | - Bruno Falissard
- INSERM U669, Département de Biostatistiques, Faculté de Médecine Paris-Sud, Hôpital Paul Brousse, AP-HP, Le Kremlin-Bicêtre, France (B.F.)
| | - Françoise Forette
- Université René Descartes, Fondation Nationale de Gérontologie, Paris, France (F.F.)
| | | | - Michel Pinget
- Service de Gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France (M.P., O.H., J.-S.V.)
| | - Rissane Ourabah
- Département de Médecine Générale (R.O.), Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
| | - Nicolas Danchin
- Service de Gériatrie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France (N.D.)
| | - Olivier Hanon
- From the EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France (L.R., M.P., O.H., J.-S.V.).,Service de Gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France (M.P., O.H., J.-S.V.)
| | - Jean-Sébastien Vidal
- From the EA 4468, Université Paris Descartes, Sorbonne Paris Cité, France (L.R., M.P., O.H., J.-S.V.).,Service de Gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, France (M.P., O.H., J.-S.V.)
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12
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Yoo JE, Shin DW, Han K, Kim D, Lee SP, Jeong SM, Lee J, Kim S. Blood Pressure Variability and the Risk of Dementia: A Nationwide Cohort Study. Hypertension 2020; 75:982-990. [PMID: 32148122 DOI: 10.1161/hypertensionaha.119.14033] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To investigate the association between visit-to-visit variability in blood pressure and the incidence of dementia and its subtypes in a general population, we conducted a population-based retrospective cohort study using the Korean National Health Insurance System database. We identified 7 844 814 subjects without a history of any dementia who underwent ≥3 health examinations from 2005 to 2012 in the Korean National Health Insurance System cohort. Blood pressure variability (BPV) was measured using the variability independent of the mean, coefficient of variation, and SD. During the median follow-up of 6.2 years, there were 200 574 cases of all-cause dementia (2.8%), 165 112 cases of Alzheimer's disease (2.1%), and 27 443 cases of vascular dementia (0.3%). There was a linear association between higher BPV and outcome measures. In the multivariable adjusted model, the hazard ratios and 95% CIs of all-cause dementia were 1.06 (1.04-1.07) for the highest quartile of variability independent of the mean of diastolic blood pressure only, 1.09 (1.08-1.11) for that of systolic blood pressure only, and 1.18 (1.16-1.19) for that of both systolic and diastolic blood pressure compared with subjects having no highest quartile for BPV. Consistent results were noted for Alzheimer's disease and vascular dementia using other indices of variability and in various sensitivity and subgroup analyses. BPV is an independent predictor for developing dementia and its subtypes. A dose-response relationship was noted between higher BPV and dementia incidence. Reducing BPV may be a target for preventing dementia in the general population.
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Affiliation(s)
- Jung Eun Yoo
- From the Department of Family Medicine, Healthcare System Gangnam Center Seoul National University Hospital, Korea (J.E.Y.)
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.W.S.).,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea (D.W.S.)
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea (K.H., D.K.)
| | - Dahye Kim
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea (K.H., D.K.)
| | - Seung-Pyo Lee
- Department of Internal Medicine (S.L.), Seoul National University Bundang Hospital & Seoul National University College of Medicine, Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea and Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA (S.-M.J.)
| | - Jinkook Lee
- Department of Economics, Center for Economic & Social Research, University of Southern California, Los Angeles, and RANC Corporation, Santa Monica, CA, USA (J.L.)
| | - SangYun Kim
- Department of Neurology (S.Y.K.), Seoul National University Bundang Hospital & Seoul National University College of Medicine, Korea
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13
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Sible IJ, Nation DA. Long-Term Blood Pressure Variability Across the Clinical and Biomarker Spectrum of Alzheimer's Disease. J Alzheimers Dis 2020; 77:1655-1669. [PMID: 32925032 PMCID: PMC8054661 DOI: 10.3233/jad-200221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Elevated blood pressure is linked to cognitive impairment and Alzheimer's disease (AD) biomarker abnormality. However, blood pressure levels vary over time. Less is known about the role of long-term blood pressure variability in cognitive impairment and AD pathophysiology. OBJECTIVE Determine whether long-term blood pressure variability is elevated across the clinical and biomarker spectrum of AD. METHODS Alzheimer's Disease Neuroimaging Initiative participants (cognitively normal, mild cognitive impairment, AD [n = 1,421]) underwent baseline exam, including blood pressure measurement at 0, 6, and 12 months. A subset (n = 318) underwent baseline lumbar puncture to determine cerebrospinal fluid amyloid-β and phosphorylated tau levels. Clinical groups and biomarker-confirmed AD groups were compared on blood pressure variability over 12 months. RESULTS Systolic blood pressure variability was elevated in clinically diagnosed AD dementia (VIM: F2,1195 = 6.657, p = 0.001, η2 = 0.01) compared to cognitively normal participants (p = 0.001), and in mild cognitive impairment relative to cognitively normal participants (p = 0.01). Findings were maintained in biomarker-confirmed AD (VIM: F2,850 = 5.216, p = 0.006, η2 = 0.01), such that systolic blood pressure variability was elevated in biomarker-confirmed dementia due to AD relative to cognitively normal participants (p = 0.005) and in biomarker-confirmed mild cognitive impairment due to AD compared to cognitively normal participants (p = 0.04). CONCLUSION Long-term systolic blood pressure variability is elevated in cognitive impairment due to AD. Blood pressure variability may represent an understudied aspect of vascular dysfunction in AD with potential clinical implications.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90007, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California, Irvine, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA
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14
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Blanken AE, Nation DA. Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation. J Alzheimers Dis 2020; 78:23-48. [PMID: 32955459 PMCID: PMC8011824 DOI: 10.3233/jad-200245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gender differences have been noted in studies linking blood pressure to all-cause dementia, and the two most common forms of dementia: Alzheimer's disease (AD) and vascular dementia (VaD). However, how gender modifies the relationship between blood pressure and dementia remains unclear. OBJECTIVE To review evidence for a gender modifying effect on the link between blood pressure and all-cause dementia. METHODS A systematic review was conducted according to PRISMA guidelines. Sixteen out of 256 reviewed articles met inclusion criteria. RESULTS For women, higher midlife systolic blood pressure (SBP) and hypertension were both associated with greater risk of all-cause dementia, AD, and VaD, in six out of seven studies. Two of these studies reported higher midlife SBP/hypertension were associated with greater risk for all-cause dementia in women, but not men. One study reported higher midlife SBP associated with greater AD risk in women, but not men. However, another study reported that midlife hypertension associated with AD risk in men, but not women. No clear gender differences were reported in the relationship between late-life high blood pressure/hypertension with all-cause dementia or AD. CONCLUSION Studies rarely, and inconsistently, analyzed or reported gender effects. Therefore, interpretation of available evidence regarding the role of gender in blood pressure associated dementia was difficult. Several studies indicated higher midlife SBP was associated with greater risk of all-cause dementia for women, compared to men. Future studies should evaluate women-specific aging processes that occur in midlife when considering the association between blood pressure and dementia risk.
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Affiliation(s)
- Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
- Institute for Memory Disorders and Neurological Impairments, University of California Irvine, Irvine, CA, USA
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15
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Day-to-day blood pressure variability is associated with lower cognitive performance among the Japanese community-dwelling oldest-old population: the SONIC study. Hypertens Res 2019; 43:404-411. [PMID: 31853044 DOI: 10.1038/s41440-019-0377-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/10/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Abstract
Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85-87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = -0.36, p = 0.034) and diastolic BP (b = -0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.
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16
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Cucci MD, Benken ST. Blood pressure variability in the management of hypertensive emergency: A narrative review. J Clin Hypertens (Greenwich) 2019; 21:1684-1692. [PMID: 31553128 PMCID: PMC8030327 DOI: 10.1111/jch.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta-analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.
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Affiliation(s)
| | - Scott T. Benken
- University of Illinois Medical CenterUniversity of Illinois‐Chicago College of PharmacyChicagoIllinois
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17
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Haring B, Liu J, Salmoirago-Blotcher E, Hayden KM, Sarto G, Roussouw J, Kuller LH, Rapp SR, Wassertheil-Smoller S. Blood pressure variability and brain morphology in elderly women without cardiovascular disease. Neurology 2019; 92:e1284-e1297. [PMID: 30814325 DOI: 10.1212/wnl.0000000000007135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/08/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To examine the relationship between blood pressure (BP) variability (BPV), brain volumes, and cognitive functioning in postmenopausal women with few modifiable cardiovascular risk factors. METHODS Study participants consisted of postmenopausal women enrolled in the Women's Health Initiative Memory MRI study (WHIMS-MRI) without cardiovascular disease, diabetes mellitus, hypertension, or current smoking at baseline (1996-1999). BP readings were taken at baseline and each annual follow-up visit. BPV was defined as the SD associated with a participant's mean BP across visits and the SD associated with the participant's regression line with BP regressed across visits. Brain MRI scans were performed between 2004 and 2006. Cognitive functioning was assessed at baseline and annually thereafter with the Modified Mini-Mental State Examination (3MSE) scoring until 2008. The final sample consisted of 558 women (mean age 69 years, median follow-up time [interquartile range] 8 [0.8] years). RESULTS In adjusted models including mean systolic BP, women in the highest tertile of systolic BPV had lower hippocampal volumes and higher lesion volumes compared to women in the lowest tertile. No relationship between BPV and 3MSE scoring was detected. CONCLUSIONS In postmenopausal women with few modifiable cardiovascular risk factors, greater visit-to-visit systolic BPV was associated with reductions in hippocampal volume and increases in lesion volumes at later life. These data add evidence to the emerging importance of BPV as a prognostic indicator even in the absence of documented cardiovascular risk factors.
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Affiliation(s)
- Bernhard Haring
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY.
| | - Jingmin Liu
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Elena Salmoirago-Blotcher
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Kathleen M Hayden
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Gloria Sarto
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Jacques Roussouw
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Lew H Kuller
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Steve R Rapp
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
| | - Sylvia Wassertheil-Smoller
- From the Department of Internal Medicine I (B.H.), University of Würzburg, Germany; Women's Health Initiative Coordinating Center (J.L.), Seattle, WA; Departments of Medicine and Epidemiology (E.S.-B.), Brown University, Providence, RI; Department of Social Sciences and Health Policy (K.M.H.) and Department of Psychiatry and Behavioral Medicine (S.R.R.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Obstetrics and Gynecology (G.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Women's Health Initiative (J.R.), National Heart, Lung, and Blood Institute, Washington, DC; Department of Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Epidemiology & Population Health (S.W.-S.), Albert Einstein College of Medicine, Bronx, NY
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Morano A, Ravera A, Agosta L, Sappa M, Falcone Y, Fonte G, Isaia G, Isaia GC, Bo M. Extent of, and variables associated with, blood pressure variability among older subjects. Aging Clin Exp Res 2018; 30:1327-1333. [PMID: 29476481 DOI: 10.1007/s40520-018-0917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Blood pressure variability (BPV) may have prognostic implications for cardiovascular risk and cognitive decline; however, BPV has yet to be studied in old and very old people. AIMS Aim of the present study was to evaluate the extent of BPV and to identify variables associated with BPV among older subjects. METHODS A retrospective study of patients aged ≥ 65 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) was carried out. Three different BPV indexes were calculated for systolic and diastolic blood pressure (SBP and DBP): standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Demographic variables and use of antihypertensive medications were considered. RESULTS The study included 738 patients. Mean age was 74.8 ± 6.8 years. Mean SBP and DBP SD were 20.5 ± 4.4 and 14.6 ± 3.4 mmHg. Mean SBP and DBP CV were 16 ± 3 and 20 ± 5%. Mean SBP and DBP ARV were 15.7 ± 3.9 and 11.8 ± 3.6 mmHg. At multivariate analysis older age, female sex and uncontrolled mean blood pressure were associated with both systolic and diastolic BPV indexes. The use of calcium channel blockers and alpha-adrenergic antagonists was associated with lower systolic and diastolic BPV indexes, respectively. CONCLUSIONS Among elderly subjects undergoing 24-h ABPM, we observed remarkably high indexes of BPV, which were associated with older age, female sex, and uncontrolled blood pressure values.
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Affiliation(s)
- Arianna Morano
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy.
| | - Agnese Ravera
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Luca Agosta
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Matteo Sappa
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Yolanda Falcone
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Gianfranco Fonte
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Gianluca Isaia
- San Luigi Gonzaga Hospital, Corso Bramante 88, Orbassano, Turin, Italy
| | - Giovanni Carlo Isaia
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Mario Bo
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
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19
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The association between blood pressure variability (BPV) with dementia and cognitive function: a systematic review and meta-analysis protocol. Syst Rev 2018; 7:163. [PMID: 30322404 PMCID: PMC6190539 DOI: 10.1186/s13643-018-0811-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/10/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A body of empirical work demonstrates that wide fluctuations in a person's blood pressure across consecutive measures, known as blood pressure variability (BPV), hold prognostic value to predict stroke and transient ischemic attack. However, the magnitude of association between BPV and other neurological outcomes remains less clear. This systematic review aims to pool together data regarding BPV with respect to incident dementia, cognitive impairment, and cognitive function. METHODS Electronic databases (MEDLINE, EMBASE, and SCOPUS) will be searched for the key words blood pressure variability and outcomes of dementia, cognitive impairment, and cognitive function. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: population-adult humans (over 18 years but with no upper age limit) without dementia at baseline, with or without elevated blood pressure, or from hypertensive populations (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or use of antihypertensive drug for hypertension) and from primary care, community cohort, electronic database registry, or randomized controlled trial (RCT); exposure-any metric of BPV (systolic, diastolic or both) over any duration; comparison-persons without dementia who do not have elevated BPV; and outcome-dementia, cognitive impairment, cognitive function at follow-up from standardized neurological assessment, or cognitive testing. Article screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, odds ratios, correlations, regression coefficients, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the neurological outcomes with Comprehensive Meta-Analysis Version 2.0 (Biostat Inc., Engelwood, NJ). DISCUSSION This systematic review aims to clarify whether BPV is associated with elevated risk for dementia, cognitive impairment, and cognitive function. An evaluation of the etiological links between BPV with incident dementia might inform evidence-based clinical practice and policy concerning blood pressure measurement and hypertension management. The review will identify sources of heterogeneity and may inform decisions on whether it is feasible and desirable to proceed with an individual participant data meta-analysis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017081977.
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Lattanzi S, Brigo F, Vernieri F, Silvestrini M. Visit-to-visit variability in blood pressure and Alzheimer's disease. J Clin Hypertens (Greenwich) 2018; 20:918-924. [PMID: 29693801 DOI: 10.1111/jch.13290] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease is the most common type of dementia and one of the leading sources of disability and dependency in the elderly. Given the limited treatment options, understanding the role of modifiable risk factors implied in the disease pathogenesis is a worthwhile endeavor to limit its global burden. Recently, the variability of blood pressure has been suggested to be a significant determinant of brain alterations and a potential therapeutic target. The aim of this article is to review the clinical evidence on the association between visit-to-visit blood pressure variability and Alzheimer's disease, highlight the underlying mechanisms, and suggest future implications.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, "Franz Tappeiner" Hospital, Merano, BZ, Italy
| | | | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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21
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Nagai M, Dote K, Kato M, Sasaki S, Oda N, Kagawa E, Nakano Y, Yamane A, Higashihara T, Miyauchi S, Tsuchiya A. Visit-to-Visit Blood Pressure Variability and Alzheimer's Disease: Links and Risks. J Alzheimers Dis 2018; 59:515-526. [PMID: 28598842 DOI: 10.3233/jad-161172] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While hypertension has been shown to be a risk factor for vascular dementia, several studies have also demonstrated that hypertension also increases the risk of Alzheimer's disease (AD). Although the relationship between visit-to-visit blood pressure variability (VVV) and cognitive impairment, including AD, have been provided, the mechanisms remain poorly understood. This review paper focuses on the relationship of VVV with AD and summarizes the pathophysiology underlying that relationship, which appears to be mediated by arterial stiffness.
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Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Shota Sasaki
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Noboru Oda
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eisuke Kagawa
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yoshinori Nakano
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Aya Yamane
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Shunsuke Miyauchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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22
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Lattanzi S, Vernieri F, Silvestrini M. Blood pressure variability and neurocognitive functioning. J Clin Hypertens (Greenwich) 2018; 20:645-647. [PMID: 29466608 DOI: 10.1111/jch.13232] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
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23
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Holm H, Nägga K, Nilsson ED, Ricci F, Melander O, Hansson O, Bachus E, Magnusson M, Fedorowski A. Biomarkers of microvascular endothelial dysfunction predict incident dementia: a population-based prospective study. J Intern Med 2017; 282:94-101. [PMID: 28407377 DOI: 10.1111/joim.12621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cerebral endothelial dysfunction occurs in a spectrum of neurodegenerative diseases. Whether biomarkers of microvascular endothelial dysfunction can predict dementia is largely unknown. We explored the longitudinal association of midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal endothelin-1 (CT-proET-1) and midregional proadrenomedullin (MR-proADM) with dementia and subtypes amongst community-dwelling older adults. METHODS A population-based cohort of 5347 individuals (men, 70%; age, 69 ± 6 years) without prevalent dementia provided plasma for determination of MR-proANP, CT-proET-1 and MR-proADM. Three-hundred-and-seventy-three patients (7%) were diagnosed with dementia (120 Alzheimer's disease, 83 vascular, 102 mixed, and 68 other aetiology) over a period of 4.6 ± 1.3 years. Relations between baseline biomarker plasma concentrations and incident dementia were assessed using multivariable Cox regression analysis. RESULTS Higher levels of MR-proANP were significantly associated with increased risk of all-cause and vascular dementia (hazard ratio [HR] per 1 SD: 1.20, 95% confidence interval [CI], 1.07-1.36; P = 0.002, and 1.52; 1.21-1.89; P < 0.001, respectively). Risk of all-cause dementia increased across the quartiles of MR-proANP (p for linear trend = 0.004; Q4, 145-1681 pmol L-1 vs. Q1, 22-77 pmol L-1 : HR: 1.83; 95%CI: 1.23-2.71) and was most pronounced for vascular type (p for linear trend = 0.005: HR: 2.71; 95%CI: 1.14-6.46). Moreover, the two highest quartiles of CT-proET-1 predicted vascular dementia with a cut-off value at 68 pmol L-1 (Q3-Q4, 68-432 pmol L-1 vs. Q1-Q2,4-68 pmol L-1 ; HR: 1.94; 95%CI: 1.12-3.36). Elevated levels of MR-proADM indicated no increased risk of developing dementia after adjustment for traditional risk factors. CONCLUSIONS Elevated plasma concentration of MR-proANP is an independent predictor of all-cause and vascular dementia. Pronounced increase in CT-proET-1 indicates higher risk of vascular dementia.
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Affiliation(s)
- H Holm
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - K Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - E D Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - F Ricci
- Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy.,Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy
| | - O Melander
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - O Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - E Bachus
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - M Magnusson
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - A Fedorowski
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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24
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Irigoyen MC, De Angelis K, Dos Santos F, Dartora DR, Rodrigues B, Consolim-Colombo FM. Hypertension, Blood Pressure Variability, and Target Organ Lesion. Curr Hypertens Rep 2016; 18:31. [PMID: 27002717 DOI: 10.1007/s11906-016-0642-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertensive patients have a higher risk of developing health complications, particularly cardiovascular (CV) events, than individuals with normal blood pressure (BP). Severity of complications depends on the magnitude of BP elevation and other CV risk factors associated with the target organ damage. Therefore, BP control and management of organ damage may contribute to reduce this risk. BP variability (BPV) has been considered a physiological marker of autonomic nervous system control and may be implicated in increased CV risk in hypertension. This review will present some evidence relating BPV and target organ damage in hypertension in clinical and experimental settings.
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Affiliation(s)
- Maria-Cláudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.
| | - Kátia De Angelis
- Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Fernando Dos Santos
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil
| | - Daniela R Dartora
- Instituto de Cardiologia do Rio Grande do Sul/ Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
| | - Bruno Rodrigues
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fernanda Marciano Consolim-Colombo
- Hypertension Unit, Heart Institute (InCor), School of Medicine, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-900, São Paulo, SP, Brazil.,Laboratory of Translational Physiology, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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