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Wu M, Lu C, Chen F, Fan Y, Li G, Zhou L. Age of hypertension onset and cognitive function in the elderly: an observational study from the NHANES 2011-2014. Eur Geriatr Med 2024; 15:561-570. [PMID: 38231294 DOI: 10.1007/s41999-023-00920-9] [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: 10/25/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE This study aims to evaluate the association between age of hypertension onset and cognitive function in a representative sample of US older adults. METHODS We assessed 2334 elderly adults (including 1655 hypertensive patients) who participated in the National Health and Nutrition Examination Survey 2011-2014. We used the age when the participants were first informed by the doctor that they had hypertension or were first clinically diagnosed with hypertension as the age of onset of hypertension. The Digit Symbol Substitution test (DSST), the Animal Fluency test, the Consortium to Establish a Registry for Alzheimer's disease (CERAD), and a composite-z score calculated by summing z-scores from these three individual tests, were used to assess cognitive function. RESULTS Participants with hypertension onset age < 35 years (early onset hypertension) had the worst performance in almost all cognitive tests, followed by those with onset age ≥ 65 years. Compared with those without hypertension, early onset hypertension was associated with - 4.15 (95% CI - 6.63, - 1.68), - 1.10 (95% CI - 2.08, - 0.12), - 0.75 (95% CI - 1.91, 0.42), and - 0.56 (95% CI - 0.94, - 0.19) scores for DSST, animal fluency test, CERAD, and composite z-score. Participants with early onset hypertension (onset age < 35 years) had higher odds for cognitive decline defined by DSST (OR: 3.28, 95% CI 1.94, 5.54) and composite z-score (OR: 1.77, 95% CI 1.07, 2.92). CONCLUSIONS Early onset hypertension was associated with the worst performance in cognitive function and an increased odds of cognitive decline in the elderly.
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Affiliation(s)
- Min Wu
- Department of Gastroenterology and Hepatology, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Cong Lu
- Institute of Cardiovascular Diseases and Department of Cardiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Fuli Chen
- Institute of Cardiovascular Diseases and Department of Cardiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yameng Fan
- School of Public Health, Xi'an Medical University, Xi'an, China
| | - Gang Li
- Institute of Cardiovascular Diseases and Department of Cardiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Long Zhou
- Institute of Cardiovascular Diseases and Department of Cardiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Meng Q, Liu M, Zu C, Su X, Wei Y, Gan X, Zhang Y, He P, Zhou C, Ye Z, Liu C, Qin X. L-shaped association between dietary zinc intake and cognitive decline in Chinese older people. Age Ageing 2024; 53:afae008. [PMID: 38287702 DOI: 10.1093/ageing/afae008] [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: 06/12/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The prospective association between dietary zinc (Zn) intake and cognitive decline remains uncertain. We aimed to assess the relationship of dietary Zn intake with the risk of cognitive decline in the Chinese older people, and examine the possible effect modifiers on this association. METHODS A total of 3,106 older Chinese adults aged 55 years or older from China Health and Nutrition Survey were included. Dietary nutrients intake information was collected by combined 24-h dietary recalls with weighing food inventory. The cognitive decline was defined as the 5-year decline rate in global and composite cognitive scores, based on a subset of items from the Telephone Interview for Cognitive Status-modified. RESULTS The median follow-up duration was 5.9 years. There was an L-shaped association between dietary Zn intake and the 5-year decline rates in global and composite cognitive scores, with an inflection point at 8.8 mg/day of dietary Zn. For the composite cognitive scores, compared with the first quantile (<7.9 mg/day) of dietary Zn intake, quantiles 2-6 (≥7.9 mg/day) had a significantly slower cognitive decline rate (β: -0.24; 95% confidence interval: -0.40 to -0.07). Similar results were found for the global cognitive scores. Moreover, the inverse association between dietary Zn intake and cognitive decline in composite cognitive scores was significantly stronger in those with lower levels of physical activity (P-interactions = 0.041). CONCLUSION Dietary Zn intake was negatively associated with cognitive decline in the older people. Maintaining appropriate dietary Zn levels may prevent cognitive decline.
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Affiliation(s)
- Qiguo Meng
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Cheng Zu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xinyue Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Yuanxiu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xiaoqin Gan
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
| | - Chengzhang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong 510515, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui 230032, China
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Xiao Y, Yang T, Zhang L, Wei Q, Ou R, Hou Y, Liu K, Lin J, Jiang Q, Shang H. Association between the blood pressure variability and cognitive decline in Parkinson's disease. Brain Behav 2023; 13:e3319. [PMID: 37969048 PMCID: PMC10726805 DOI: 10.1002/brb3.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES High visit-to-visit blood pressure variability (BPV) was found to be associated with cognitive decline in the elderly. This study aimed to investigate the impact of visit-to-visit BPV on cognition in patients with early-stage Parkinson's disease (PD). DESIGN This is a retrospective analysis of a prospective cohort. SETTING AND PARTICIPANTS A total of 297 patients with early-stage PD (103 mild cognitive impairments [PD-MCI] and 194 normal cognitions [PD-NC] at baseline) were included from the Parkinson's Progression Markers Initiative study. METHODS Variation independent of mean (VIM) of the first year was used as the indicator of BPV. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition. Patients were divided into PD-MCI and PD-NC according to the MoCA score at baseline. Longitudinal cerebrospinal fluid (Aβ-42, Aβ, α-synuclein, neurofilament light protein, tau phosphorylated at the threonine 181 position, total tau, glial fibrillary acidic protein) and serum (neurofilament light protein) biomarkers were assessed. The Bayesian linear growth model was used to evaluate the relationship between baseline BPV and the rate of change in cognition and biomarkers. RESULTS Higher systolic VIM of the first year was related to a greater rate of decline in MoCA score in the following years in PD-MCI (β = -.15 [95% CI -.29, -.01]). No association was found between BPV and biomarkers. CONCLUSION AND IMPLICATIONS Higher systolic VIM predicted a steeper decline in cognitive tests in PD-MCI independently from the mean value of blood pressure, orthostatic hypotension, and supine hypertension.
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Affiliation(s)
- Yi Xiao
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Tianmi Yang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lingyu Zhang
- Health Management CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Qianqian Wei
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Ruwei Ou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yanbing Hou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Kuncheng Liu
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Junyu Lin
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Qirui Jiang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Huifang Shang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
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Meng Q, Liu C, Zu C, Wei Y, Su X, Gan X, Zhang Y, He P, Zhou C, Liu M, Ye Z, Qin X. Association Between Dietary Copper Intake and Cognitive Decline: A Perspective Cohort Study in Chinese Elderly. Am J Geriatr Psychiatry 2023; 31:753-763. [PMID: 37263860 DOI: 10.1016/j.jagp.2023.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The association between dietary copper (Cu) intake and cognitive decline remains uncertain. We aim to investigate the longitudinal association of dietary Cu with cognitive decline in Chinese elderly. METHODS A total of 3,106 Chinese adults aged older than or equal to 55 years from China Health and Nutrition Survey (CHNS) were included. Dietary nutrients information was collected by 24-hours dietary recalls in combination with a food-weighted method. The 5-year change rates in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified (TICS-m) was calculated as the last-survey score minus the baseline score, then divided by the follow-up time (unit, years) and multiplied by five. RESULTS The median follow-up duration was 5.9 years. There was a nonlinear association of dietary Cu intake with the 5-year change rates in global or composite cognitive scores, with the inflection point at approximately 1.3 mg/day of dietary Cu intake. Accordingly, for the composite cognitive score, compared to the first quantile (<1.28 mg/day), those with dietary Cu in quantiles 2-8 (≥1.28 mg/day) had a significantly slower cognitive decline rate (B, 0.30; 95% CI, 0.13, 0.47). Similar results were found for the global cognitive score. Moreover, the inverse association between dietary Cu and cognitive decline was stronger in those with lower dietary fat intake and lower levels of physical activity (All p-interactions <0.05). CONCLUSION There was a nonlinear inverse association of dietary Cu intake with cognitive decline in the elderly, with an inflection point at approximately 1.3 mg/day of dietary Cu intake.
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Affiliation(s)
- Qiguo Meng
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Chengzhang Liu
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Cheng Zu
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yuanxiu Wei
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xinyue Su
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xiaoqin Gan
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Panpan He
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Mengyi Liu
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xianhui Qin
- Department of Epidemiology and Biostatistics (QM, CL, CZ, YW, XS, XQ), School of Public Health, Anhui Medical University, Hefei, Anhui, China; Institute of Biomedicine (QM, CL, CZ, YW, XS, XQ), Anhui Medical University, Hefei, China; Division of Nephrology (QM, CL, CZ, YW, XS, XG, YZ, PH, CZ, ML, ZY, XQ), Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.
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Lin X, Zhao J, Ge S, Lu H, Xiong Q, Guo X, Li L, He S, Wang J, Peng F, Fan Y, Zuo X, Tian C, Ying C. Dietary Polyphenol Intake and Risk of Hypertension: An 18-y Nationwide Cohort Study in China. Am J Clin Nutr 2023; 118:264-272. [PMID: 37146758 PMCID: PMC10447504 DOI: 10.1016/j.ajcnut.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Although increasing evidence suggests that polyphenol helps regulate blood pressure (BP), evidence from large-scale and long-term population-based studies is still lacking. OBJECTIVES This study aimed to investigate the association between dietary polyphenol and hypertension risk in the China Health and Nutrition Survey (N = 11,056). METHODS Food intake was assessed using 3-d, 24-h dietary recalls and household weighing method; polyphenol intake was calculated by multiplying consumption of each food and its polyphenol content. Hypertension was defined as BP ≥ 140/90 mmHg, physicians' diagnosis, or taking antihypertension medications. HR and 95% CI were estimated using mixed-effects Cox models. RESULTS During 91,561 person-years of follow-up, a total of 3866 participants developed hypertension (35%). The lowest multivariable-adjusted HR (95% CI) of hypertension risk occurred in the third quartile intake, which was 0.63 (0.57, 0.70) for total polyphenol, 0.61 (0.55, 0.68) for flavonoid, 0.62 (0.56, 0.69) for phenolic acid, 0.46 (0.42, 0.51) for lignan, and 0.58 (0.52, 0.64) for stilbene, compared with the lowest quartile. The polyphenol-hypertension associations were nonlinear (all Pnonlinearity < 0.001), and different patterns were observed. U-shaped relations with hypertension were observed for total polyphenol, flavonoid, and phenolic acid, whereas L-shaped associations were observed for lignan and stilbene. Moreover, higher fiber intake strengthened the polyphenol-hypertension association, especially for lignan (P-interaction = 0.002) and stilbene (P-interaction = 0.004). Polyphenol-containing food, particularly vegetables and fruits rich in lignan and stilbene, were significantly associated with lower hypertension risk. CONCLUSIONS This study demonstrated an inverse and nonlinear association between dietary polyphenol, especially lignan and stilbene, and hypertension risk. The findings provide implications for hypertension prevention.
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Affiliation(s)
- Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Haidong Lu
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, United States; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuiqing He
- Department of Nutrition, Hunan Chest Hospital, Hunan Institute For Tuberculosis Control, Changsha, China
| | - Jinxue Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Fan
- Shenzhen Longhua District Chronic Disease Control Center, Shenzhen, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Liu C, Meng Q, Zu C, Wei Y, Su X, Zhang Y, He P, Zhou C, Liu M, Ye Z, Qin X. Dietary low- and high-quality carbohydrate intake and cognitive decline: A prospective cohort study in older adults. Clin Nutr 2023; 42:1322-1329. [PMID: 37413810 DOI: 10.1016/j.clnu.2023.06.021] [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: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND & AIMS The association of dietary intake of carbohydrate (CHO), especially high- and low-quality CHO, with the decline of cognitive function remains uncertain. We aimed to investigate the prospective association of dietary total, low- and high-quality CHO intake with cognitive decline, and further examine the effect of isocaloric substitution with protein or fat, in the elderly population. METHODS A total of 3106 Chinese participants aged ≥55 years from China Health and Nutrition Survey (CHNS) were included in this study. Dietary nutrient intake information was collected by 24-h dietary recalls on 3 consecutive days. The cognitive decline was defined as the 5-year decline rates in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified (TICS-m). RESULTS The median follow-up duration was 5.9 years. There was a significantly positive association of dietary low-quality CHO (per 10 percentage energy [%E] increment, β, 0.06; 95%CI, 0.01-0.11) and a no significant association of dietary high-quality CHO (per 10%E increment, β, 0.04; 95%CI, -0.07-0.14) with the 5-year decline rate in the composite cognitive scores. Similar results were found for the global cognitive scores. In model simulations, substituting dietary low-quality CHO with isocaloric animal protein or fat, instead of isocaloric plant protein or fat, was significantly and inversely associated with cognitive decline (All P values < 0.05). CONCLUSIONS The dietary intake of low-quality CHO, rather than high-quality CHO, was significantly associated with a faster cognitive decline in the elderly. In model simulations, isocaloric substitution of dietary low-quality CHO with animal protein or fat, rather than plant protein or fat, was inversely associated with cognitive decline.
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Affiliation(s)
- Chengzhang Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Qiguo Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Cheng Zu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Yuanxiu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Xinyue Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Institute of Biomedicine, Anhui Medical University, Hefei 230032, China.
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7
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Sun F. The impact of blood pressure variability on cognition: current limitations and new advances. J Hypertens 2023; 41:888-905. [PMID: 37016905 PMCID: PMC10158606 DOI: 10.1097/hjh.0000000000003422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 04/06/2023]
Abstract
Dementia is the most common neurodegenerative disease in the aging population. Emerging evidence indicates that blood pressure (BP) variability is correlated with cognitive impairment and dementia independent of mean BP levels. The state-of-the-art review summarizes the latest evidence regarding the impact of BP variability on cognition in cognitively intact populations, patients with mild cognitive impairment, and different dementia types, focusing on the important confounding factors and new advances. This review also summarizes the potential mechanisms underlying the relationship between BP variability and cognitive impairment, and dementia, briefly discussing sex differences in the relationship. At last, current limitations and future perspectives are discussed to optimize BP management in preventing cognitive impairment and dementia.
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Affiliation(s)
- Fen Sun
- Department of Anatomy, College of Basic Medicine
- Key Laboratory of Organ Development and Regeneration of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
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8
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Coon EA, Castillo AM, Lesnick TG, Raghavan S, Mielke MM, Reid RI, Windham BG, Petersen RC, Jack CR, Graff-Radford J, Vemuri P. Blood pressure changes impact corticospinal integrity and downstream gait and balance control. Neurobiol Aging 2022; 120:60-67. [PMID: 36122540 PMCID: PMC9613619 DOI: 10.1016/j.neurobiolaging.2022.08.011] [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: 01/31/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
Abstract
Blood pressure (BP) plays an important role in white matter integrity. We sought to determine the role of intra-individual BP changes on white matter and evaluate the impact on gait speed and imbalance by sex. We identified 990 eligible participants in the population-based Mayo Clinic Study of Aging and analyzed fractional anisotropy (FA) in white matter regions. Using structural equation models (SEM), we assessed the effect of BP slope on corticospinal tract (CST) FA and downstream effects on gait speed and imbalance after age and sex effects. Of 990 participants, 438 (44%) were female with mean age of 76 years. In linear models predicting CST FA, a greater change in BP slope (0.0004; p = 0.026) and female sex (0.017; p < 0.001) were significant predictors of lower CST FA. SEMs showed that older age, female sex, and higher BP slope predicted lower CST FA, and lower CST FA predicted worse downstream motor control. Therefore, intra-individual BP slope and variability impact corticospinal tract microstructural properties of white matter with females having increased susceptibility to damage.
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Affiliation(s)
| | - Anna M Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - B Gwen Windham
- Department of Medicine and Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
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9
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Zhang S, Deng F, Chen J, Chen F, Wu Z, Li L, Hou K. Fecal microbiota transplantation treatment of autoimmune-mediated type 1 diabetes: A systematic review. Front Cell Infect Microbiol 2022; 12:1075201. [PMID: 36530444 PMCID: PMC9751335 DOI: 10.3389/fcimb.2022.1075201] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
There is a strong link between fecal microbiota and the development of type 1 diabetes. As an emerging therapeutic modality, fecal microbiota transplantation has been shown to be safe and effective in the treatment of many intestinal and extraintestinal diseases. Various studies have found that fecal microbiota transplantation can treat diseases by correcting patients' immune disorders. Besides, many studies have found that fecal microbiota transplantation can improve glycemic control and insulin resistance in diabetic patients. Therefore, this paper reviews the mechanism of action of fecal microbiota transplantation on autoimmune-mediated T1DM and the current research progress, feasibility, and issues that need to be addressed in the future development of fecal microbiota transplantation in the treatment of autoimmune-mediated T1DM.
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Affiliation(s)
- Shuo Zhang
- Shantou University Medical College, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Feiying Deng
- Shantou University Medical College, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jingxian Chen
- Department of Endocrine and Metabolic Diseases, Longhu People’s Hospital, Shantou, China
- School of Public Health, Shantou University, Shantou, China
| | - Fengwu Chen
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Endocrine and Metabolic Diseases, Longhu People’s Hospital, Shantou, China
| | - Zezhen Wu
- Shantou University Medical College, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Liping Li
- School of Public Health, Shantou University, Shantou, China
| | - Kaijian Hou
- Department of Endocrine and Metabolic Diseases, Longhu People’s Hospital, Shantou, China
- School of Public Health, Shantou University, Shantou, China
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10
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Yu JH, Kim REY, Park SY, Lee DY, Cho HJ, Kim NH, Yoo HJ, Seo JA, Kim SH, Kim SG, Choi KM, Baik SH, Shin C, Kim NH. Night blood pressure variability, brain atrophy, and cognitive decline. Front Neurol 2022; 13:963648. [PMID: 36119712 PMCID: PMC9474888 DOI: 10.3389/fneur.2022.963648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Although blood pressure variability (BPV) has emerged as a novel risk factor for Alzheimer's disease, few studies have examined the effects of night BPV on brain structure and function. This study investigated the association of night BPV with brain atrophy and cognitive function changes. Methods The analysis included 1,398 participants with valid ambulatory blood pressure (BP) monitoring at baseline and both baseline and 4-year follow-up brain magnetic resonance images who were recruited from the Korean Genome and Epidemiology Study. Participants underwent a comprehensive neuropsychological test battery. BPV was derived from ambulatory BP monitoring and calculated as a standard deviation (SD) of 24-h and daytime and nighttime BP. Results During the median follow-up of 4.3 years, increased SD of night systolic or diastolic BP was an indicator of total brain volume reduction, while daytime BPV or night average BP was not associated with total brain volume changes. High SD of night systolic BP was associated with reduced gray matter (GM) volume, independent of average night BP, and use of antihypertensive drugs. It also was associated with a reduction of temporal GM volume, mostly driven by atrophy in the left entorhinal cortex and the right fusiform gyrus. In cognitive performance, high variability of night systolic BP was associated with a decrease in visual delayed recall memory and verbal fluency for the category. Conclusion Increased night BPV, rather than night mean BP, was associated with reduced brain volume and cognitive decline. High night BPV could be an independent predictor for rapid brain aging in a middle-aged population.
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Affiliation(s)
- Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Regina E. Y. Kim
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyun Joo Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seong Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- *Correspondence: Nan Hee Kim
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11
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Asmuje NF, Mat S, Myint PK, Tan MP. Blood Pressure Variability and Cognitive Function: a Scoping Review. Curr Hypertens Rep 2022; 24:375-383. [PMID: 35731334 DOI: 10.1007/s11906-022-01200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To conduct a scoping review of articles which have evaluated BPV and cognitive function. Articles with keywords, titles or abstracts containing the terms 'cognitive' OR 'cognition' OR 'dementia' AND 'blood pressure variability' were identified from CINAHL, Medline, PMC and Web of Science. RECENT FINDINGS Methods of acquisition and analysis of BPV and cognitive measurements and their relationship were extracted from selected articles. Of 656 studies identified, 53 articles were selected. Twenty-five evaluated long-term (LTBPV), nine mid-term (MTBPV), 12 short-term (STBPV) and nine very short-term BPV (VSTBPV) with conflicting findings on the relationship between BPV and cognition. Variations existed in devices, period and procedure for acquisition. The studies also utilized a wide range of methods of BPV calculation. Thirteen cognitive assessment tools were used to measure global cognition or domain functions which were influenced by the population of interest. The interpretation of available studies was hence limited by heterogeneity. There is an urgent need for standardization of BPV assessments to streamline research on BPV and cognition. Future studies should also establish whether BPV could be a potential modifiable risk factor for cognitive decline, as well as a marker for treatment response.
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Affiliation(s)
- Nur Fazidah Asmuje
- Kolej Genius Insan, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia. .,Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Sumaiyah Mat
- Physiotherapy Programme and Center of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Department of Medicine for the Elderly, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. .,Centre for Innovations in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia. .,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
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12
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Sible IJ, Yew B, Dutt S, Li Y, Blanken AE, Jang JY, Ho JK, Marshall AJ, Kapoor A, Gaubert A, Bangen KJ, Sturm VE, Shao X, Wang DJ, Nation DA. Selective vulnerability of medial temporal regions to short-term blood pressure variability and cerebral hypoperfusion in older adults. NEUROIMAGE. REPORTS 2022; 2:100080. [PMID: 35784272 PMCID: PMC9249026 DOI: 10.1016/j.ynirp.2022.100080] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Blood pressure variability is an emerging risk factor for stroke, cognitive impairment, and dementia, possibly through links with cerebral hypoperfusion. Recent evidence suggests visit-to-visit (e.g., over months, years) blood pressure variability is related to cerebral perfusion decline in brain regions vulnerable to Alzheimer's disease. However, less is known about relationships between short-term (e.g., < 24 hours) blood pressure variability and regional cerebral perfusion, and whether these relationships may differ by age. We investigated short-term blood pressure variability and concurrent regional cerebral microvascular perfusion in a sample of community-dwelling older adults without history of dementia or stroke and healthy younger adults. Blood pressure was collected continuously during perfusion MRI. Cerebral blood flow was determined for several brain regions implicated in cerebrovascular dysfunction in Alzheimer's disease. Elevated systolic blood pressure variability was related to lower levels of concurrent cerebral perfusion in medial temporal regions: hippocampus (β = -.60 [95% CI -.90, -.30]; p < .001), parahippocampal gyrus (β = -.57 [95% CI -.89, -.25]; p = .001), entorhinal cortex (β = -.42 [95% CI -.73, -.12]; p = .009), and perirhinal cortex (β = -.37 [95% CI -.72, -.03]; p = .04), and not in other regions, and in older adults only. Findings suggest a possible age-related selective vulnerability of the medial temporal lobes to hypoperfusion in the context of short-term blood pressure fluctuations, independent of average blood pressure, white matter hyperintensities, and gray matter volume, which may underpin the increased risk for dementia associated with elevated BPV.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Belinda Yew
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Shubir Dutt
- 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
| | - Yanrong Li
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA
| | - Anna E. Blanken
- 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, Irvine, CA 92697, USA
| | - Jean K. Ho
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, 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
| | - Aimée Gaubert
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA
| | - Katherine J. Bangen
- Research Service, Veteran Affairs San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Virginia E. Sturm
- Department of Neurology, University of California, San Francisco, San Francisco, CA, 94158, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, 94158, USA,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Xingfeng Shao
- Laboratory of Functional MRI Technology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, 90033, USA
| | - Danny J. Wang
- Laboratory of Functional MRI Technology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, 90033, USA
| | - Daniel A. Nation
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA 92697, USA,Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA,Corresponding Author: Daniel A. Nation, Ph.D., Associate Professor, University of California Irvine, Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, Phone: (949) 824-9339,
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13
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Daniel GD, Chen H, Bertoni AG, Hughes TM, Hayden KM. High visit‐to‐visit blood pressure variability predicts global cognitive decline: The Multi‐Ethnic Study of Atherosclerosis. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12342. [PMID: 35898668 PMCID: PMC9310191 DOI: 10.1002/trc2.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- George D. Daniel
- Department of Neurobiology and Anatomy Wake Forest School of Medicine Winston‐Salem North Carolina USA
- Department of Psychology Howard University Washington DC USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Timothy M. Hughes
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston‐Salem North Carolina USA
- Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina USA
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14
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Pallangyo P, Mkojera ZS, Komba M, Mgopa LR, Bhalia S, Mayala H, Wibonela S, Misidai N, Swai HJ, Millinga J, Chavala E, Kisenge PR, Janabi M. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol 2021; 21:433. [PMID: 34749692 PMCID: PMC8573988 DOI: 10.1186/s12883-021-02467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. METHODOLOGY A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. CONCLUSION This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.
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Affiliation(s)
- Pedro Pallangyo
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Makrina Komba
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | | | - Jalack Millinga
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R. Kisenge
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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15
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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: 61] [Impact Index Per Article: 20.3] [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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16
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Ma Y, Hua R, Yang Z, Zhong B, Yan L, Xie W. Different hypertension thresholds and cognitive decline: a pooled analysis of three ageing cohorts. BMC Med 2021; 19:287. [PMID: 34724953 PMCID: PMC8561998 DOI: 10.1186/s12916-021-02165-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for high blood pressure (BP) in adults came up with a new definition of hypertension with a threshold BP level of 130/80 mmHg. But the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines adhered to a conventional hypertension definition as BP ≥ 140/90 mmHg. We aimed to compare the trajectories of cognitive decline between participants with BP < 130/80 mmHg in all BP measurement waves and others with all BP < 140/90 mmHg. METHODS This pooled analysis involved middle-aged and older participants from three nationally representative ageing cohorts, including the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health Retirement Longitudinal Study (CHARLS). Participants were divided into the Normal (BP < 130/80 mmHg on all occasions throughout the study), the Borderline (BP < 140/90 mmHg on all occasions throughout the study but not in the Normal group), and the High (the rest of participants) BP groups. Global cognitive Z score was calculated from tests on memory, executive function, and orientation. RESULTS A total of 17,590 participants (HRS 6964, median follow-ups 12 years; ELSA 5334, median follow-ups 16 years; CHARLS 5292, median follow-ups 7 years) were included. No significant difference in global cognitive decline rate was detected between the Normal and the borderline groups (men, pooled β = - 0.006 standard deviation [SD]/year; 95% confidence interval [CI], - 0.020 to 0.008; P = 0.377; women, pooled β = 0.006 SD/year; 95% CI - 0.005 to 0.018; P = 0.269). Participants in the High group had a significantly faster cognitive decline (men, pooled β = - 0.011 SD/year; 95% CI - 0.020 to - 0.002; P = 0.013; women, pooled β = - 0.017 SD/year; 95% CI - 0.026 to - 0.008; P < 0.001) than that in the Borderline group. CONCLUSIONS Individuals in the Borderline group did not experience significantly faster cognitive decline compared with those in the Normal group. It might not be necessary for individuals with borderline BP (between 130/80 and 140/90 mmHg) to initiate antihypertension therapy in consideration of cognitive decline.
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Affiliation(s)
- Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
| | - Zhenchun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Baoliang Zhong
- Department of Geriatric Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Li Yan
- National School of Development, Peking University, Beijing, China.
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China.
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17
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Xiao H, Li H, Dong L, Song X, Wu Y, Wei H, Shang W, Tian M, Dong J. Correlation between home systolic blood pressure variability and cognitive impairment in maintenance hemodialysis patients. Semin Dial 2021; 35:129-137. [PMID: 34585445 PMCID: PMC9293001 DOI: 10.1111/sdi.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
Introduction To investigate the correlation between home blood pressure variability and cognitive function in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD were included. Their home blood pressure on nondialysis days within 1 week was collected. All patients were assessed with the Montreal Cognitive Assessment scale, according to which the patients were divided into cognitive impairment (CI) group and non‐CI group, and the differences between two groups were compared. Results A total of 224 patients were included in the study, of which 168 had CI (75%). Compared with non‐CI group, patients in CI group had larger variability of systolic blood pressure (SBPV) (8.4 [6.7, 10.6]% vs. 6.9 [4.9, 8.8]%, P < 0.001). The smooth fitting curve (OR = 1.2, 95% CI [1.1–1.4], P < 0.001) and trend test (P for trend = 0.004) showed that the risk of CI raised with the increase of SBPV. The patients were further divided into tertiles according to the SBPV. We also found a gradual increase in the proportion of incident CI in the three tertiles. Multiple logistic regression analysis showed that age, shorter years of education, less frequency of hemodialysis, and greater SBPV were the dependent risk of CI. Conclusion In conclusion, greater SBPV indicates higher risk of cognitive impairment in MHD patients.
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Affiliation(s)
- Huihui Xiao
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, China.,Department of internal medicine, Jianghan University, Wuhan, Hubei, China
| | - Hua Li
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohong Song
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yang Wu
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Honglan Wei
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weifeng Shang
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ming Tian
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Junwu Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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18
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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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19
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Jia P, Lee HWY, Chan JYC, Yiu KKL, Tsoi KKF. Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies. Hypertension 2021; 78:996-1004. [PMID: 34397274 DOI: 10.1161/hypertensionaha.121.17788] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pingping Jia
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong
| | - Helen W Y Lee
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, Faculty of Medicine (J.Y.C.C.), The Chinese University of Hong Kong
| | - Karen K L Yiu
- Stanley Ho Big Data Decision Analytics Research Centre (K.K.L.Y., K.K.F.T.), The Chinese University of Hong Kong
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong.,Stanley Ho Big Data Decision Analytics Research Centre (K.K.L.Y., K.K.F.T.), The Chinese University of Hong Kong
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20
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Lee KP, Chang AYW, Sung PS. Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment. Biomedicines 2021; 9:773. [PMID: 34356837 PMCID: PMC8301473 DOI: 10.3390/biomedicines9070773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Alice Y. W. Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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21
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Ernst ME, Ryan J, Chowdhury EK, Margolis KL, Beilin LJ, Reid CM, Nelson MR, Woods RL, Shah RC, Orchard SG, Wolfe R, Storey E, Tonkin AM, Brodtmann A, McNeil JJ, Murray AM. Long-Term Blood Pressure Variability and Risk of Cognitive Decline and Dementia Among Older Adults. J Am Heart Assoc 2021; 10:e019613. [PMID: 34176293 PMCID: PMC8403315 DOI: 10.1161/jaha.120.019613] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Methods and Results ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P=0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19–2.39) but not women (HR, 1.01; 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P=0.15; men: HR, 1.36; 95% CI, 1.16–1.59; women: HR, 1.14; 95% CI, 0.98–1.32). Conclusions High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583; isrctn.com. Identifier: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science College of Pharmacy The University of Iowa Iowa City IA.,Department of Family Medicine Carver College of Medicine The University of Iowa Iowa City IA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | | | - Lawrence J Beilin
- Medical School Royal Perth HospitalUniversity of Western Australia Perth Western Australia Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,School of Public Health Curtin University Perth Western Australia Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Raj C Shah
- Department of Family Medicine Rush University Medical Center Chicago IL.,Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research Hennepin-Health Research InstituteHennepin Healthcare Minneapolis MN.,Division of Geriatrics Department of Medicine Hennepin Healthcare Minneapolis MN
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22
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Li C, Ma Y, Hua R, Yang Z, Zhong B, Wang H, Xie W. Dose-Response Relationship Between Long-Term Blood Pressure Variability and Cognitive Decline. Stroke 2021; 52:3249-3257. [PMID: 34167328 DOI: 10.1161/strokeaha.120.033697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship. METHODS Original survey data from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Standardized Z score of cognitive function was the main outcome measure. Visit-to-visit blood pressure SD, coefficient of variation, and variation independent of mean were used. Linear mixed model and restricted spline were applied to assess association and explore dose-response pattern. Segmented regression was used to analyze dose-response relationship and estimate turning point. Meta-analysis using random-effects model was conducted to pool results, with I2 used to test heterogeneity. RESULTS A total of 12 298 dementia-free participants were included (mean age: 64.6±8.6 years). Significant association was observed between blood pressure variability and cognitive decline. Each 10% increment in coefficient of variation of systolic and diastolic blood pressure was associated with accelerated global cognitive decline of 0.026 SD/y (95% CI, 0.016-0.036, P<0.001) and 0.022 SD/y (95% CI, 0.017-0.027, P<0.001), respectively. Nonlinear dose-response relationship was found (P<0.001 for nonlinearity), with clear turning point observed (P<0.001 for change in slopes). CONCLUSIONS Higher long-term blood pressure variability was associated with accelerated cognitive decline among general adults aged ≥50 years, with nonlinear dose-response relationship. Further randomized controlled trials are warranted to evaluate potential benefits of blood pressure variability-lowering strategies from a cognitive health perspective.
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Affiliation(s)
- Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (C.L., Y.M., R.H., W.X.).,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China (C.L., Y.M., R.H., H.W., W.X.)
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (C.L., Y.M., R.H., W.X.).,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China (C.L., Y.M., R.H., H.W., W.X.)
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (C.L., Y.M., R.H., W.X.).,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China (C.L., Y.M., R.H., H.W., W.X.)
| | - Zhenchun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom (Z.Y.)
| | - Baoliang Zhong
- Department of Geriatric Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China (B.Z.)
| | - Hongyu Wang
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Vascular Medicine Center, Peking University Shougang Hospital, Beijing, China (H.W.)
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (C.L., Y.M., R.H., W.X.).,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China (C.L., Y.M., R.H., H.W., W.X.)
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23
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Chiu TJ, Yeh JT, Huang CJ, Chiang CE, Sung SH, Chen CH, Cheng HM. Blood pressure variability and cognitive dysfunction: A systematic review and meta-analysis of longitudinal cohort studies. J Clin Hypertens (Greenwich) 2021; 23:1463-1482. [PMID: 34153171 PMCID: PMC8678719 DOI: 10.1111/jch.14310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 01/13/2023]
Abstract
The variability of blood pressure (BPV) has been suggested as a clinical indicator for cognitive dysfunction, yet the results from clinical studies are variable. This study investigated the relationship between BPV and the risk of cognitive decline or dementia. Bibliographic databases, including PubMed, Scopus, and Embase, were searched systematically for longitudinal cohort studies with BPV measurements and neuropsychological examinations or dementia diagnosis. A traditional meta‐analysis with subgroup analysis, and a further dose‐response meta‐analysis were conducted. Twenty cohort studies with 7 924 168 persons were included in this review. The results showed that a higher systolic BPV (SBPV), when measured with the coefficient of variation (SBP‐CV) or standard deviation (SBP‐SD), was associated with a higher risk of all‐cause dementia diagnosis but not incidence of cognitive decline on neuropsychological examinations. In subgroup analysis, the effect was more prominent when using BPV of shorter timeframes, during shorter follow‐ups, or among the elderly aged more than 65 years. No dose‐response relationship could be found. Our study suggested possible positive associations between SBPV and the risk of dementia. Further studies are required to validate these findings.
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Affiliation(s)
- Tzu-Jung Chiu
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Jiunn-Tyng Yeh
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Chi-Jung Huang
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Hu H, Meng L, Bi YL, Zhang W, Xu W, Shen XN, Ou YN, Ma YH, Dong Q, Tan L, Yu JT. Tau pathologies mediate the association of blood pressure with cognitive impairment in adults without dementia: The CABLE study. Alzheimers Dement 2021; 18:53-64. [PMID: 34031984 DOI: 10.1002/alz.12377] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION This study delineated the interrelationships among blood pressure (BP), cerebrospinal fluid (CSF) core biomarkers of Alzheimer's disease (AD), and cognition. METHODS The linear regression analyses were conducted in 1546 non-demented participants (mean age of 61.58 years, range 40 to 89 years; 40% female; average days of BP measurement, 9.10 days). Mediation analyses with 10,000 bootstrapped iterations were used to explore the mediation effects. RESULTS A clear age-related pattern of BP was delineated. Mid-life hypertension (especially systolic BP), late-life lower diastolic BP, as well as mid- and late-life higher pulse pressure were associated with cognitive impairment and tau-related biomarkers. BP variability was associated only with cognition but not with CSF biomarkers. Overall, the associations between BP and cognition were partially mediated (proportion: 11% to 30%) by tau pathologies, independently of amyloid pathology. DISCUSSION Tau pathologies might play important roles in the relationship between BP and cognition, with significant age- and BP-type dependences.
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Affiliation(s)
- Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Li Meng
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan-Lin Bi
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao University, China
| | - Wei Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xue-Ning Shen
- From Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- From Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- From Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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25
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Sible IJ, Yew B, Dutt S, Bangen KJ, Li Y, Nation DA. Visit-to-visit blood pressure variability and regional cerebral perfusion decline in older adults. Neurobiol Aging 2021; 105:57-63. [PMID: 34034215 DOI: 10.1016/j.neurobiolaging.2021.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Abstract
Blood pressure variability (BPV) is linked to dementia risk, possibly through cerebral hypoperfusion. We investigated BPV over 1 year and concurrent regional cerebral perfusion decline in older adults without dementia. Participants underwent 4 blood pressure measurements across 12 months, ASL-MRI at baseline and 12-months, and baseline FDG-PET. Regional perfusion was normalized to precentral gyrus. A subset had cerebral spinal fluid Alzheimer's disease biomarker abnormalities. For every SD increase in BPV, perfusion decreased in medial orbitofrontal cortex (ß = -.36; p = 0.008), hippocampus (ß = -.37; p = 0.005), entorhinal cortex (ß = -.48; p < 0.001), precuneus (ß = -.31; p = 0.02), inferior parietal cortex (ß = -.44; p < 0.001), and inferior temporal cortex (ß = -.46; p < 0.001). Similar patterns emerged in subsets with biomarker abnormalities. Older adults with elevated BPV exhibit concurrent regional perfusion decline in areas vulnerable to Alzheimer's disease, independent of cerebral hypometabolism. BPV may be an early marker of vascular dysfunction in aging.
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Affiliation(s)
- Isabel J Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Belinda Yew
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Shubir Dutt
- Department of Psychology, University of Southern California, Los Angeles, CA, USA; Davis School of Gerontology, 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
| | - Yanrong Li
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Daniel A Nation
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Psychological Science, University of California, Irvine, CA, USA.
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26
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Kim Y, Lim JS, Oh MS, Yu KH, Lee JS, Park JH, Kim YJ, Rha JH, Hwang YH, Heo SH, Ahn SH, Lee JH, Kwon SU. Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis. Sci Rep 2021; 11:5049. [PMID: 33658545 PMCID: PMC7930263 DOI: 10.1038/s41598-021-83945-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/18/2021] [Indexed: 12/27/2022] Open
Abstract
Blood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
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Abstract
PURPOSE OF REVIEW The relationship between hypertension and Alzheimer's disease (AD) is complex and varies across the lifespan. Studies have suggested that midlife hypertension is a risk factor for AD, although studies of late life hypertension have suggested that it either has no effect or a weak protective effect. RECENT FINDINGS Animal models of induced and spontaneous hypertension have found that AD pathological change (β-amyloid plaques and tau tangles) occurs within weeks of a hypertensive insult. Human imaging and autopsy studies indicate that midlife and late life hypertension are associated with increased AD pathological change. Meta-analyses of longitudinal studies indicate that midlife rather than late life hypertension is a risk factor for AD. New areas of research have suggested that rather than mean blood pressure (BP), it is the negative BP trajectories or the variability of BP that contributes to AD. In a number of meta-analyses of antihypertensive medications and their effect on AD, there were weak associations between improved AD outcomes and treatment. SUMMARY The combined analysis of animal, human clinical/pathological, epidemiological and drug trial data indicates that hypertension increases the risk of AD and treatment of hypertension may be an appropriate preventive measure.
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28
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Zhou J, Walker RL, Gray SL, Marcum ZA, Barthold D, Bowen JD, McCormick W, McCurry SM, Larson EB, Crane PK. Glucose-Dementia Association Is Consistent Over Blood Pressure/Antihypertensive Groups. J Alzheimers Dis 2021; 80:79-90. [PMID: 33554906 DOI: 10.3233/jad-201138] [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: 11/15/2022]
Abstract
BACKGROUND Higher glucose levels are associated with dementia risk in people with and without diabetes. However, little is known about how this association might vary by hypertension status and antihypertensive treatment. Most studies on modifiable dementia risk factors consider each factor in isolation. OBJECTIVE To test the hypothesis that hypertension and antihypertensive treatments may modify associations between glucose levels and dementia. METHODS Analyses of data generated from a research study and clinical care of participants from a prospective cohort of dementia-free older adults, including glucose measures, diabetes and antihypertensive treatments, and blood pressure data. We defined groups based on blood pressure (hypertensive versus not, ≥140/90 mmHg versus <140/90 mmHg) and antihypertensive treatment intensity (0, 1, or ≥2 classes of antihypertensives). We used Bayesian joint models to jointly model longitudinal exposure and time to event data. RESULTS A total of 3,056 participants without diabetes treatment and 480 with diabetes treatment were included (mean age at baseline, 75.1 years; mean 7.5 years of follow-up). Higher glucose levels were associated with greater dementia risk among people without and with treated diabetes. Hazard ratios for dementia were similar across all blood pressure/antihypertensive treatment groups (omnibus p = 0.82 for people without and p = 0.59 for people with treated diabetes). CONCLUSION Hypertension and antihypertensive treatments do not appear to affect the association between glucose and dementia risk in this population-based longitudinal cohort study of community-dwelling older adults. Future studies are needed to examine this question in midlife and by specific antihypertensive treatments.
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Affiliation(s)
- Jing Zhou
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Rod L Walker
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Shelly L Gray
- Departments of Pharmacy, University of Washington, Seattle, WA, USA
| | - Zachary A Marcum
- Departments of Pharmacy, University of Washington, Seattle, WA, USA
| | - Douglas Barthold
- Departments of Pharmacy, University of Washington, Seattle, WA, USA
| | - James D Bowen
- Department of Neurology, Swedish Hospital Medical Center, Seattle, WA, USA
| | - Wayne McCormick
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- Departments of Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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29
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Zhang Z, Liu M, Zhou C, He P, Zhang Y, Li H, Li Q, Liu C, Qin X. Evaluation of Dietary Niacin and New-Onset Hypertension Among Chinese Adults. JAMA Netw Open 2021; 4:e2031669. [PMID: 33404619 PMCID: PMC7788463 DOI: 10.1001/jamanetworkopen.2020.31669] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE The relationship of dietary niacin intake with the risk of hypertension remains unknown. OBJECTIVE To determine the prospective association between dietary niacin intake and new-onset hypertension, and examine factors that may modify the association among Chinese adults. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study of 12 243 Chinese adults used dietary intake data from 7 rounds of the China Health and Nutrition Survey. Dietary intake was measured by 3 consecutive 24-hour dietary recalls from participants in combination with a weighing inventory taken over the same 3 days at the household level. Statistical analysis was conducted from May 2020 to August 2020. EXPOSURES Dietary intake. MAIN OUTCOMES AND MEASURES The study outcome was new-onset hypertension, defined as systolic blood pressure 140 mm Hg or greater and/or diastolic blood pressure 90 mm Hg or greater, diagnosis by physician, or current antihypertensive treatment during the follow-up. RESULTS The mean (SD) age of the study population was 41.2 (14.2) years, and 5728 (46.8%) of participants were men. The mean (SD) dietary niacin intake level was 14.8 (4.1) mg/d. A total of 4306 participants developed new-onset hypertension during a median (interquartile range) follow-up duration of 6.1 (3.6-11.3) years. When dietary niacin was assessed in quartiles, the lowest risk of new-onset hypertension was found in participants in quartile 3 (14.3 to <16.7 mg/d; adjusted hazard ratio, 0.83; 95% CI, 0.75-0.90) compared with those in quartile 1 (<12.4 mg/d). Consistently in the threshold analysis, for every 1 mg/d increase in dietary niacin, there was a 2% decrease in new-onset hypertension (adjusted HR, 0.98; 95% CI, 0.96-1.00) in those with dietary niacin intake less than 15.6 mg/d, and a 3% increase in new-onset hypertension (adjusted HR, 1.03; 95% CI, 1.02-1.04) in participants with dietary niacin 15.6 mg/d or greater. Based on these results, there was a J-shaped association between dietary niacin intake and new-onset hypertension in the general population of Chinese adults, with an inflection point at 15.6 mg/d and a minimal risk at 14.3 to 16.7 mg/d (quartile 3) of dietary niacin intake. CONCLUSIONS AND RELEVANCE The results of this study provide some evidence for maintaining the optimal dietary niacin intake levels for the primary prevention of hypertension.
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Affiliation(s)
- Zhuxian Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Mengyi Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Chun Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Panpan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yuanyuan Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Huan Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Qinqin Li
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Chengzhang Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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30
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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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31
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O'Caoimh R, Gao Y, Svendrovski A, Illario M, Iaccarino G, Yavuz BB, Kehoe PG, Molloy DW. Effect of Visit-to-Visit Blood Pressure Variability on Cognitive and Functional Decline in Mild to Moderate Alzheimer's Disease. J Alzheimers Dis 2020; 68:1499-1510. [PMID: 30909214 DOI: 10.3233/jad-180774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability (VVV) is increasingly recognized as a marker of cardiovascular risk. Although implicated in cognitive decline, few studies are currently available assessing its effects on established dementia. OBJECTIVE To investigate if VVV is associated with one-year rate of decline in measures of cognition and function in patients with mild to moderate Alzheimer's disease (AD) in the Doxycycline And Rifampicin for Alzheimer's Disease study. METHODS Patients were included if ≥3 BP readings were available (n = 392). VVV was defined using different approaches including the coefficient of variation (CV) in BP readings between visits. Outcomes included rates of decline in the Standardized Alzheimer's Disease Assessment Scale-Cognitive Subscale (SADAS-cog), Standardized MMSE, Clinical Dementia Rating Scale, the Quick Mild Cognitive Impairment screen and the Lawton-Brody activities of daily living (ADL) scale. RESULTS Half of the patients (196/392) had a ≥4-point decline in the SADAS-cog over one-year. Using this cut-off, there were no statistically significant associations between any measures of VVV, for systolic or diastolic BP, with and without adjustment for potential confounders including treatment allocation, history of hypertension and use of anti-hypertensive and cognitive enhancing medications. Multiple regression models examining the association between systolic BP CV by quartile and decline over one-year likewise showed no clinically significant effects, apart from a U-shaped pattern of ADL decline of borderline clinical significance.∥Conclusions: This observational study does not support recent research showing that VVV predicts cognitive decline in AD. Further studies are needed to clarify its effects on ADL in AD.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | | | - Maddalena Illario
- Division on Health Innovation, Campania Region Health Directorate; DISMET/R&D Unit, Federico II University and Hospital, Naples, Italy
| | - Guido Iaccarino
- Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy
| | - Burcu Balam Yavuz
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Patrick Gavin Kehoe
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
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32
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Heart Rate, Brain Imaging Biomarkers and Cognitive Impairment in Older (≥63 years) Women. Am J Cardiol 2020; 129:102-108. [PMID: 32576368 PMCID: PMC9879294 DOI: 10.1016/j.amjcard.2020.05.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 01/28/2023]
Abstract
Evidence on the relations between heart rate, brain morphology, and cognition is limited. We examined the associations of resting heart rate (RHR), visit-to-visit heart rate variation (VVHRV), brain volumes and cognitive impairment. The study sample consisted of postmenopausal women enrolled in the Women's Health Initiative Memory Study and its ancillary MRI sub-studies (WHIMS-MRI 1 and WHIMS-MRI 2) without a history of cardiovascular disease, including 493 with one and 299 women with 2 brain magnetic resonance imaging (MRI) scans. HR readings were acquired annually starting from baseline visit (1996-1998). RHR was calculated as the mean and VVHRV as standard deviation of all available HR readings. Brain MRI scans were performed between 2005 and 2006 (WHIMS-MRI 1), and approximately 5 years later (WHIMS-MRI 2). Cognitive impairment was defined as incident mild cognitive impairment or probable dementia until December 30, 2017. An elevated RHR was associated with greater brain lesion volumes at the first MRI exam (7.86 cm3 [6.48, 9.24] vs 4.78 cm3 [3.39, 6.17], p-value <0.0001) and with significant increases in lesion volumes between brain MRI exams (6.20 cm3 [4.81, 7.59] vs 4.28 cm3 [2.84, 5.73], p-value = 0.0168). Larger ischemic lesion volumes were associated with a higher risk for cognitive impairment (Hazard Ratio [95% confidence interval], 2.02 [1.18, 3.47], p-value = 0.0109). Neither RHR nor VVHRV were related to cognitive impairment. In sensitivity analyses, we additionally included women with a history of cardiovascular disease to the study sample. The main results were consistent to those without a history of cardiovascular disease. In conclusion, these findings show an association between elevated RHR and ischemic brain lesions, probably due to underlying subclinical disease processes.
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33
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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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34
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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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35
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Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka. Int J Hypertens 2019; 2019:6450281. [PMID: 31885898 PMCID: PMC6915156 DOI: 10.1155/2019/6450281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022] Open
Abstract
Visit-to-visit variability (VVV) is a relatively new concept in the hypertensive arena. Data regarding VVV are lacking in our region, and factors associated with VVV are rarely examined in previous studies. This study was conducted among 406 patients attended to the cardiology outpatient department of Teaching Hospital, Jaffna, Sri Lanka, in 2018 to assess the long-term variability of blood pressure (BP) by reviewing last six consecutive BP readings from the records retrospectively. Data regarding sociodemographic variables and behavioural factors such as medication adherence, physical activity, smoking, alcohol consumption, and relevant comorbidities were taken through an interviewer-administered questionnaire. Data were analysed by using SPSS version 25 and VVV of systolic blood pressure (SBP) matrix expressed as mean of SD and association were examined with various factors and VVV of SBP. SBP showed high VVV among the participants as expressed by mean of SD which was 13.06 ± 5.64. When comparing mean SD among the categories of different variables, female sex (P=0.023) and comorbidities such as diabetes mellitus (DM) (P=0.013), chronic kidney disease (CKD) (P=0.007), and risk of developing obstructive sleep apnoea (OSA) (P=0.04) showed significant variation. Medication adherence to prescribed hypertensive medication was a major issue even though significant association was not found with high VVV (P=0.536). The SD of SBP was then classified into high and low VVV groups by means of a cutoff point at the 50th percentile. Bivariate analysis by using Chi-squared test revealed comorbidities such as DM, CKD, and physical activity (P=0.044) were significantly associated with high VVV. Further multivariate regression analysis revealed that comorbidities such as DM and CKD have 1.561 times and 5.999 times more risk to show high variability, respectively. In conclusion, we recommend simple practical measures to achieve sustainable BP control among hypertensive patients with DM and CKD to minimize the VVV and improve their cardiovascular outcome.
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36
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Zhou TL, Kroon AA, van Sloten TT, van Boxtel MPJ, Verhey FRJ, Schram MT, Köhler S, Stehouwer CDA, Henry RMA. Greater Blood Pressure Variability Is Associated With Lower Cognitive Performance. Hypertension 2019; 73:803-811. [PMID: 30739535 DOI: 10.1161/hypertensionaha.118.12305] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An increasing number of individuals will face age-related cognitive difficulties because life expectancy has increased. It is, therefore, important to identify modifiable risk factors for cognitive impairment. Very short-term to mid-term blood pressure variability (BPV) may be such a factor because it may cause cerebral ischemia. To this end, we investigated whether greater systolic and diastolic BPV are cross-sectionally associated with memory function (n=1804), information processing speed (n=1793), and executive function (n=1780) in 40- to 75-year-old individuals from The Maastricht Study. A composite BPV-index was derived by standardizing within-visit, 24-hour, and 7-day BPV. We performed linear regression with adjustments for age, sex, educational level, 24-hour systolic or diastolic pressure, and cardiovascular risk factors. We found that a 1-SD greater systolic BPV was not associated with information processing speed (β [SD difference], -0.10; 95% CI, -0.14 to 0.06), or executive function (-0.09; 95% CI, -0.20 to 0.02) but was marginally associated with lower memory function (-0.11; 95% CI, -0.21 to 0.00). A 1-SD greater diastolic BPV was associated with lower information processing speed (-0.10; 95% CI, -0.20 to -0.00) and executive function (-0.12; 95% CI, -0.22 to -0.01) and marginally associated with lower memory function (-0.09; 95% CI, -0.20 to 0.01). These effects on cognitive performance are equivalent to ≈3 additional years of aging. In conclusion, greater very short-term to mid-term diastolic and, to a lesser extent, systolic BPV may be a modifiable risk factor for cognitive deterioration in 40- to 75-year-old, community-dwelling individuals.
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Affiliation(s)
- Tan Lai Zhou
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Abraham A Kroon
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S.).,Department of Epidemiology and Department of Arterial Mechanics, INSERM, UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S.)
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Miranda T Schram
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Coen D A Stehouwer
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Ronald M A Henry
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
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de Heus RA, Olde Rikkert MG, Tully PJ, Lawlor BA, Claassen JA. Blood Pressure Variability and Progression of Clinical Alzheimer Disease. Hypertension 2019; 74:1172-1180. [DOI: 10.1161/hypertensionaha.119.13664] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer’s Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer’s Disease Assessment Scale–cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer’s Disease Assessment Scale–cognitive subscale compared with patients in the lowest quartile (systolic: β, 2.24 [95% CI, 0.11–4.38],
P
=0.040; diastolic: β, 2.54 [95% CI, 0.33–4.75]
P
=0.024). This association was still present after 1.5 years (systolic: β, 2.86 [95% CI, 0.35–5.36],
P
=0.026; diastolic: β, 3.30 [95% CI, 0.67–5.93],
P
=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer’s Disease Assessment Scale–cognitive subscale (systolic:
P
=0.036) and Disability Assessment for Dementia (systolic:
P
=0.020; diastolic:
P
=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease.
Clinical Trial Registration
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Phillip J. Tully
- School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Brian A. Lawlor
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland (B.A.L.)
- Department of Medical Gerontology, Trinity College Institute of Neuroscience, Dublin, Ireland (B.A.L.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
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Inoue Y, Howard AG, Qin B, Yazawa A, Stickley A, Gordon-Larsen P. The association between family members' migration and cognitive function among people left behind in China. PLoS One 2019; 14:e0222867. [PMID: 31557218 PMCID: PMC6762087 DOI: 10.1371/journal.pone.0222867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
While internal migration is widely occurring in countries across the world and older people are more likely to be left behind by family members who out-migrated to other locations, little attention has been paid to the cognitive health of those people who have been left behind (PLB). Understanding how these demographic patterns relate to older persons' cognitive health may inform efforts to reduce the disease burden due to cognitive decline. Data came from the China Health and Nutrition Survey in 1997, 2000 and 2004. Participants aged 55 to 93 who participated in a cognitive function screening test (score range: 0-31) in two or more waves and provided information on family members' migration (n = 1,267) were included in the analysis. A mixed linear model was used to investigate the association between being left behind by any members who had not resided in the household for at least 6 months at baseline and cognitive function. Approximately 10% of the participants had been left behind by family members who migrated out of their communities. A significant interaction was observed in relation to cognitive function between being left behind and the number of years from the first test. Specifically, there was a less steep decline in cognitive function of PLB compared to people not left behind. This longitudinal study showed that PLB tended to have a higher cognitive function compared to those not left behind due to their relatively stable transition in cognitive function during the study period.
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Affiliation(s)
- Yosuke Inoue
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Annie Green Howard
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Bo Qin
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States of America
| | - Aki Yazawa
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Penny Gordon-Larsen
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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39
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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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40
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Tadic M, Cuspidi C, Bombelli M, Facchetti R, Mancia G, Grassi G. Relationships between residual blood pressure variability and cognitive function in the general population of the PAMELA study. J Clin Hypertens (Greenwich) 2018; 21:39-45. [PMID: 30427125 DOI: 10.1111/jch.13428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/26/2023]
Abstract
The present study was aimed at assessing the relationships between absolute and individual residual blood pressure (BP) variability and cognitive function in a general population. This cross-sectional study evaluated cognitive function using minimental state evaluation (MMSE) in 471 subjects enrolled in the PAMELA study. MMSE was calculated 10 years after initial enrollment of the subjects in the PAMELA study. Measurements included office, home, and 24-hour ambulatory BP monitoring. BP variability was obtained by calculating: (a) 24-hour standard deviation (SD) for systolic and diastolic BP and (b) individual residual BP variability. Mean age (±SD) of the subjects enrolled was 63 ± 5.7 years at the initial evaluation, with a 10-year increase when MMSE was performed. There was no significant difference in BP or heart rate values measured at office, home, or during 24-h BP monitoring between subjects with MMSE < 24 and those with ≥24. BP variability measured by SBP and DBP SD was also similar between these two groups. However, individual residual BP variability was significantly greater in subjects with lower MMSE and this difference became more pronounced when the study population was divided in three groups according to MMSE score (10-20, 21-23, 24-30). Individual residual SBP and DBP variability gradually decreased with the increase in MMSE score. Our data show that a sensitive parameter for the development of cognitive impairment is not BP or absolute BP variability but rather its short-term erratic component, which has been previously shown to be an important prognostic marker for organ damage, cardiovascular, and all-cause mortality.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Michele Bombelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Rita Facchetti
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Milan, Italy
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41
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Lima NKC. Hypertension and cognition decline: Is there an ultimate link? J Clin Hypertens (Greenwich) 2018; 20:1584-1586. [DOI: 10.1111/jch.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Nereida K. C. Lima
- Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto Brazil
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42
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Yano Y, Griswold M, Wang W, Greenland P, Lloyd‐Jones DM, Heiss G, Gottesman RF, Mosley TH. Long-Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study. J Am Heart Assoc 2018; 7:e009578. [PMID: 30371241 PMCID: PMC6201456 DOI: 10.1161/jaha.118.009578] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
Abstract
Background To understand how blood pressure ( BP ) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change. Methods and Results The ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BP s) between 1987 and 1998, and their mean levels and average real variability ( ARV ) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP ( SBP )/diastolic BP ( DBP ) level was 123/72 mm Hg, and ARVSBP / ARVDBP was 11/7 mm Hg. With linear mixed models, 1- SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], -0.03 [-0.04 to -0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], -0.02 [-0.03 to -0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], -0.04 [-0.06 to -0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02-0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP , was associated with change in global cognitive z scores from visits 4 to 5. Conclusions Greater visit-to-visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.
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Affiliation(s)
- Yuichiro Yano
- Department of Preventive MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Michael Griswold
- Center of Biostatistics and BioinformaticsUniversity of Mississippi Medical CenterJacksonMS
| | - Wanmei Wang
- Center of Biostatistics and BioinformaticsUniversity of Mississippi Medical CenterJacksonMS
| | - Philip Greenland
- Department of Preventive MedicineNorthwestern UniversityFeinberg School of MedicineChicagoIL
| | - Donald M. Lloyd‐Jones
- Department of Preventive MedicineNorthwestern UniversityFeinberg School of MedicineChicagoIL
| | - Gerardo Heiss
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | | | - Thomas H. Mosley
- Division of Geriatric MedicineUniversity of Mississippi Medical CenterJacksonMS
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43
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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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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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45
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Tzourio C. Short-Term Blood Pressure Variability and Cognition in the Elderly: Mere Association or a Key Mechanism? Am J Hypertens 2018; 31:284-286. [PMID: 29036265 DOI: 10.1093/ajh/hpx170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, Bordeaux, France
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46
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Laosiripisan J, Haley AP, Tanaka H. Steady State vs. Pulsatile Blood Pressure Component and Regional Cerebral Perfusion. Am J Hypertens 2017; 30:1100-1105. [PMID: 29059301 DOI: 10.1093/ajh/hpx108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Arterial blood pressure (BP) can be divided into steady state component that is determined by mean arterial pressure and pulsatile component that is explored by pulse pressure (PP). We determined relationships between BP components and regional cerebral perfusion. METHODS A total of 52 apparently healthy and cognitively normal adults aged 40-60 years were studied. Regional cerebral perfusion was measured using functional magnetic resonance imaging (MRI) arterial spin labeling technique in 10 a priori regions of interest. RESULTS There were 5 regions with cerebral perfusion values significantly associated with either pulsatile BP component (i.e., hippocampus, posterior insula, and central white matter) or both steady and pulsatile components (i.e., anterior white matter, and occipitoparietal area). After controlling for body mass index, education, age, and sex, associations between pulsatile BP components and regional cerebral perfusion remained significant in 2 regions (i.e., hippocampus and anterior white matter). Multiple linear regression analyses revealed that brachial systolic pressure (β = -0.35, P = 0.03) and PP (β = -0.36, P = 0.02) explained 11 and 12% of the variability in hippocampus perfusion, independent of the entered covariates. CONCLUSIONS The present preliminary study indicated that pulsatile component of BP was more strongly related to regional cerebral perfusion in areas susceptible to cerebrovascular diseases than steady state component.
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47
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Age modifies the relation between intraindividual measurement-to-measurement variation in blood pressure and cognitive function: the Maine-Syracuse Study. J Hypertens 2017; 36:268-276. [PMID: 28787305 DOI: 10.1097/hjh.0000000000001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence to suggest that intraindividual variability in blood pressure (BP IIV) may be superior to mean BP for predicting cognitive function, taken from both within a single visit and between-visits. BP IIV increases with age in studies of persons middle-aged and older. The aim was therefore to investigate age by BP IIV (SBP and DBP) interactions with regard to cognitive functioning while considering medication class and polypharmacy, which may also affect BP IIV with advancing age. METHOD AND RESULTS Cross-sectional analyses were performed on 980 community-dwelling individuals from the Maine-Syracuse Longitudinal Study. Automated BP measures were taken 15 times (five times each in sitting, reclining, and standing positions). Cognitive function was assessed using a thorough neuropsychological test battery following the BP assessment. A significant age by BP IIV interaction was observed. For individuals aged over age 60 years, IIV in SBP and DBP was inversely associated with Global Composite, Scanning and Tracking, and the Similarities test. IIV in SBP was additionally associated with Verbal Memory and the Mini-Mental State Examination. DBP IIV was additionally related to the Visual-Spatial Memory and Organization composite. There were no significant associations between BP IIV and cognitive function in those aged less than 60 years. CONCLUSION BP IIV is an important predictor of cognition with advancing age.
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Geng S, Liu N, Meng P, Ji N, Sun Y, Xu Y, Zhang G, He X, Cai Z, Wang B, Xu B, Li Z, Niu X, Zhang Y, Xu B, Zhou X, He M. Midterm Blood Pressure Variability Is Associated with Poststroke Cognitive Impairment: A Prospective Cohort Study. Front Neurol 2017; 8:365. [PMID: 28804475 PMCID: PMC5532726 DOI: 10.3389/fneur.2017.00365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/11/2017] [Indexed: 01/27/2023] Open
Abstract
Objective The aim of this study was to investigate the relationship between blood pressure variability (BPV) and poststroke cognitive impairment (PSCI). Methods Seven-hundred ninety-six patients with acute ischemic stroke were included in this study. Midterm BPV was evaluated by calculating the SD and coefficient of variation (CV, 100 × SD/mean) of systolic blood pressure (SBP) and diastolic blood pressure during the 7 days after stroke onset. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at admission and at all follow-up visits. Patients with MoCA scores <26 were considered to have PSCI. Results The incidence of PSCI reached its peak (72%) 3 months after stroke onset and decreased to 30.3% at 12 months poststroke. After adjusting for covariables, the increase in the prevalence of PSCI at 3 months was independently associated with increases in the CV of blood pressure during the 7 days after stroke [odds ratios and 95% CI for patients in the second to fifth quintiles of SBP CV were 2.28 (1.18, 4.39), 2.33 (1.18, 4.62), 2.69 (1.31, 5.53), and 4.76 (1.95, 11.67), respectively]. Sub-analysis of the MoCA scores revealed that the patients had impairments in visuoperceptual abilities and executive functions, as well as in naming and delayed recall (p < 0.05). Conclusion Midterm BPV during the early phase of acute ischemic stroke is independently associated with PSCI, especially in the visuoperceptual, executive, and delayed recall domains. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-TRC-14004804.
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Affiliation(s)
- Shan Geng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Na Liu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Pin Meng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Niu Ji
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yong'an Sun
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yingda Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Guanghui Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaobing He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zenglin Cai
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Wang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zaipo Li
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaoqin Niu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yongjin Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bingchao Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xinyu Zhou
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Mingli He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Weiss A, Rudman Y, Beloosesky Y, Akirov A, Shochat T, Grossman A. High blood pressure variability predicts 30-day mortality but not 1-year mortality in hospitalized elderly patients. Blood Press 2017; 26:259-263. [PMID: 28270031 DOI: 10.1080/08037051.2017.1300859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association of blood pressure (BP) variability (BPV) in hospitalized patients, which represents day-to-day variability, with mortality has been extensively reported in patients with stroke, but poorly defined for other medical conditions. AIM AND METHOD To assess the association of day-to-day blood pressure variability in hospitalized patients, 10 BP measurements were obtained in individuals ≥75 years old hospitalized in a geriatric ward. Day-to-day BPV, measured 3 times a day, was calculated in each patient as the coefficient of variation of systolic BP. Patients were stratified by quartiles of coefficient of variation of systolic BP, and 30-day and 1-year mortality data were compared between those in the highest versus the lowest (reference) group. RESULTS Overall, 469 patients were included in the final analysis. Mean coefficient of variation of systolic BP was 12.1%. 30-day mortality and 1-year mortality occurred in 29/469 (6.2%) and 95/469 (20.2%) individuals respectively. Patients in the highest quartile of BPV were at a significantly higher risk for 30-day mortality (HR =4.12, CI 1.12-15.10) but not for 1-year mortality compared with the lowest BPV quartile (HR =1.61, CI 0.81-3.23). CONCLUSIONS Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.
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Affiliation(s)
- Avraham Weiss
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yaron Rudman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Yichayaou Beloosesky
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amit Akirov
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Unit of Endocrinology and Metabolism , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Tzippy Shochat
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Bio-statistical Unit , Rabin Medical Center, Beilinson Campus , Petah Tikva , Israel
| | - Alon Grossman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
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