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Li X, Hui Y, Shi H, Li R, Lv H, Wu Y, Li J, Zhang S, Liang X, Chen S, Zhao P, Wu S, Wang Z. Gray matter volume mediates the association of long-term blood pressure variability with cognitive function in an adult population. Alzheimers Dement 2024; 20:4476-4485. [PMID: 38872387 PMCID: PMC11247661 DOI: 10.1002/alz.13865] [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: 08/29/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION We delineated the associations among long-term blood pressure variability (BPV), brain structure, and cognitive function. METHODS We included 1254 adult participants from the Kailuan study. BPV was calculated from 2006 to 2020. Brain magnetic resonance imaging (MRI) and Montreal Cognitive Assessment (MoCA) were conducted in 2020. RESULTS Higher systolic BPV (SBPV) and diastolic BPV (DBPV) were associated with lower total and frontal gray matter (GM) volume, and higher SBPV was associated with lower temporal GM volume. Elevated DBPV was associated with lower volume of total brain and parietal GM, and higher white matter hyperintensity (WMH) volume. Higher SBPV and DBPV were associated with lower MoCA scores. Decreased total and regional GM volume and increased WMH volume were associated with lower MoCA scores. The association between SBPV and cognitive function was mediated by total, frontal, and temporal GM volume. DISCUSSION GM volume may play key roles in the association between SBPV and cognitive function. HIGHLIGHTS SBPV and DBPV were negatively associated with total and regional brain volume. SBPV and DBPV were negatively associated with cognitive function. Decreased brain volume was associated with cognitive decline. GM volume mediated the negative association between SBPV and cognitive function.
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Affiliation(s)
- Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Hui
- Department of MRI, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Huijing Shi
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Rui Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Jing Li
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Shun Zhang
- Department of Psychiatry, Kailuan Mental Health Centre, Tangshan, Hebei Province, China
| | - Xiaoliang Liang
- Department of Psychiatry, Kailuan Mental Health Centre, Tangshan, Hebei Province, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Li Q, Su S, Feng Y, Jia M, Zhan J, Liao Z, Li J, Li X. Potential role of blood pressure variability and plasma neurofilament light in the mechanism of comorbidity between Alzheimer's disease and cerebral small vessel disease. Alzheimers Dement 2024; 20:4891-4902. [PMID: 38895921 PMCID: PMC11247680 DOI: 10.1002/alz.14056] [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: 02/29/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Long-term blood pressure variability (BPV) and plasma neurofilament light (pNfL) have been identified as potential biomarkers for Alzheimer's disease (AD) and cerebral small vessel disease (CSVD). However, the relationship between BPV, pNfL, and their association with the comorbidity of AD and CSVD remains unknown. METHODS Participants with normal cognition and mild cognitive impairment from the Alzheimer's Disease Neuroimaging Initiative study were included in the data analysis. Linear mixed-effects regression models and causal mediation analyses were conducted to investigate the relationship among BPV, pNfL, comorbidity-related brain structural changes (hippocampal atrophy and white matter hyperintensities [WMH]), and cognitive function. RESULTS BPV was associated with pNfL, volumes of hippocampus and WMH, and cognition. pNfL mediated the effects of BPV on brain structural changes and cognition. DISCUSSION Our findings suggest a potential role of BPV and pNfL in the mechanism of comorbidity between AD and CSVD, underscoring the importance of BPV intervention in the general population. HIGHLIGHTS Individuals with both Alzheimer's disease (AD) and cerebral small vessel disease (CSVD) pathologies had elevated blood pressure variability (BPV) and plasma neurofilament light (pNfL). The association between different components of BPV and brain structural changes may vary. BPV was associated with pNfL levels independent of average blood pressure. pNfL mediated the effects of BPV on comorbidity-related brain structural changes and cognitive performance.
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Grants
- cstc2019jcyj-zdxmX0029 Chongqing Natural Science Fund Key Project
- GE Healthcare
- Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University
- AbbVie
- Transition Therapeutics
- Cogstate
- Eisai Inc.
- W81XWH-12-2-0012 Department of Defense
- EuroImmun
- Biogen
- CSTB2023NSCQ-MSX0198 Chongqing Natural Science Fund General Program
- Alzheimer's Disease Neuroimaging Initiative
- Alzheimer's Drug Discovery Foundation
- Servier
- Lumosity
- Bristol-Myers Squibb Company
- U01 AG024904 NIA NIH HHS
- Piramal Imaging
- Takeda Pharmaceutical Company
- Alzheimer's Association
- Genentech, Inc.
- Araclon Biotech
- U01 AG024904 NIH HHS
- Meso Scale Diagnostics, LLC
- Novartis Pharmaceuticals Corporation
- CereSpir, Inc.
- BioClinica, Inc.
- NIBIB NIH HHS
- Johnson & Johnson Pharmaceutical Research & Development LLC
- Pfizer Inc.
- Elan Pharmaceuticals, Inc.
- F. Hoffmann-La Roche Ltd.
- Eli Lilly and Company
- IXICO Ltd.
- NeuroRx Research
- Merck & Co., Inc.
- Janssen Alzheimer Immunotherapy Research & Development, LLC
- Neurotrack Technologies
- Fujirebio
- Lundbeck
- Alzheimer's Disease Neuroimaging Initiative
- National Institutes of Health
- Department of Defense
- National Institute on Aging
- National Institute of Biomedical Imaging and Bioengineering
- AbbVie
- Alzheimer's Association
- Alzheimer's Drug Discovery Foundation
- BioClinica, Inc.
- Biogen
- Bristol‐Myers Squibb Company
- Eli Lilly and Company
- F. Hoffmann‐La Roche Ltd.
- Genentech, Inc.
- Fujirebio
- GE Healthcare
- Lundbeck
- Merck & Co., Inc.
- Novartis Pharmaceuticals Corporation
- Pfizer Inc.
- Servier
- Takeda Pharmaceutical Company
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Affiliation(s)
- Qin Li
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Shu Su
- Department of Epidemiology and BiostatisticsThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yuxue Feng
- Department of NeurologyUniversity of the Chinese Academy of Sciences Chongqing Renji HospitalChongqingChina
| | - Meng Jia
- Department of Epidemiology and BiostatisticsThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiehong Zhan
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zixuan Liao
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiayu Li
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaofeng Li
- Department of NeurologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Key Laboratory of Major Brain Disease and Aging Research (Ministry of Education)Chongqing Medical UniversityChongqingChina
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Duan L, Xiao R, Liu S, Shi Y, Feng Y. Causality between cognitive performance and cardiovascular disease: A bidirectional Mendelian randomization study. Gene 2024; 891:147822. [PMID: 37758004 DOI: 10.1016/j.gene.2023.147822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Growing evidence points to a connection between cardiovascular disease and cognitive impairment. These observational study findings, however, were not all uniform, and some did not discover a link like this. Investigating the causal link between cognitive impairment and cardiovascular disease is vital. METHOD Using publicly available genome-wide association study (GWAS) summary datasets and stringent screening instrumental variables, we carried out a bidirectional Mendelian randomization study. To investigate the causality between cardiovascular disease and cognitive impairment, three different MR techniques-inverse variance weighted (IVW), MR-Egger, and weighted median-as well as various sensitivity analyses-Cochran's Q, ivw_radial, leave-one-out (LOO), MR-Egger intercept, and MR-PRESSO-were used. RESULTS The causal impact of genetically predicted cognitive performance on hypertension, atrial fibrillation, heart failure, coronary atherosclerosis, coronary artery disease, and myocardial infarction was detected in the forward MR analysis, but not stroke or any subtypes. We only discover the causal effects of hypertension, any stroke, and its subtypes (ischemic and small vessel stroke) on cognitive performance in the reverse MR analysis. CONCLUSION This MR analysis offers proof of a causal link between cognitive impairment and elevated cardiovascular disease risk. Our research emphasizes the value of cognitively impaired patients being screened for cardiovascular disease, which may offer fresh perspectives on cardiovascular disease prevention.
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Affiliation(s)
- Lincheng Duan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rong Xiao
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shupei Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Shi
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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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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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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Abstract
BACKGROUND Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures. METHODS AND RESULTS The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume. CONCLUSION Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.
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Peters R, Xu Y, Eramudugolla R, Sachdev PS, Cherbuin N, Tully PJ, Mortby ME, Anstey KJ. Diastolic Blood Pressure Variability in Later Life May Be a Key Risk Marker for Cognitive Decline. Hypertension 2022; 79:1037-1044. [PMID: 35176867 DOI: 10.1161/hypertensionaha.121.18799] [Citation(s) in RCA: 2] [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 There is an increasing awareness of the need to understand the interaction between long-term blood pressure patterns and their impact on the brain and cognition. METHODS Our aim was to investigate the relationship between repeated blood pressure measures and change in cognitive performance over 12 years and imaging data at 12 years using a longitudinal population study. The data consisted of 2 cohorts, one midlife and one later life. Using linear regression, we examined the relationship between blood pressure (systolic, diastolic, change in blood pressure between visits, and visit-to-visit variability), change in cognitive performance and imaging at 12 years. RESULTS Data on cognitive change were available in 1054 at midlife, baseline age 42.7 (SD 1.5) and 1233 in later life, 62.5 (1.5) years. Imaging data were available in 168 and 233, respectively. After adjustment for multiple comparisons greater diastolic blood pressure variability in later life was associated with a -1.95 point decline (95% CI, -2.89 to -1.01) on an attention-based task and a -0.42 point (95% CI, -0.68 to -0.15) decline in performance on a psychomotor task. A higher SD in diastolic pressure across follow-up was associated with greater white matter hyperintensity volume (%increase per 10 mm Hg increase in the SD [1.50 (95% CI, 1.16-1.94]). CONCLUSIONS In a largely normotensive/mildly hypertensive population, our analyses reported no relationships between blood pressure and cognition in midlife but a potential role for diastolic blood pressure variability in later life as a risk marker for cognitive decline. This may indicate an at-risk period or a means to identify an at-risk population at the age where diastolic pressure is starting to decline.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Ying Xu
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Ranmalee Eramudugolla
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Australia. (P.S.S.).,Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney, Australia (P.S.S.)
| | | | | | - Moyra E Mortby
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
| | - Kaarin J Anstey
- Neuroscience Research Australia, NSW (R.P., Y.X., R.E., M.E.M., K.J.A.).,School of Psychology, University of New South Wales, Australia. (R.P., Y.X., R.E., M.E.M., K.J.A.)
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Liu L, Hayden KM, May NS, Haring B, Liu Z, Henderson VW, Chen JC, Gracely EJ, Wassertheil-Smoller S, Rapp SR. Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e42-e53. [PMID: 35112096 PMCID: PMC8804967 DOI: 10.1016/s2666-7568(21)00283-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Whether blood pressure (BP), and at what level of controlled BP, reduces risk of cognitive impairment remains uncertain. We investigated the association of BP and hypertension treatment status with mild cognitive impairment and dementia in older women. METHODS We prospectively analysed a sample of 7207 community-dwelling women aged 65-79 years participating in the Women's Health Initiative Memory Study (WHIMS). Participants were recruited between May 28, 1996, and Dec 13, 1999, at 39 US clinical centres, and they were followed up until Dec 31, 2019. Cognitive function was assessed annually. Mild cognitive impairment and probable dementia were defined through a centralised adjudication process. BP was measured by trained and certified staff at baseline. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Hypertension was defined using the American Heart Association 2017 Guideline for High BP in Adults. Outcomes were (1) mild cognitive impairment, (2) probable dementia, and (3) cognitive loss (the combined endpoint of either mild cognitive impairment or probable dementia, or both). We estimated hazard ratios (HRs) to assess the association between hypertension, SBP, and PP with the risk of study outcomes using Cox proportional hazards regression models, with adjustment for key covariates. FINDINGS During a median follow-up of 9 years (IQR 6-15), 1132 (15·7%) participants were classified as mild cognitive impairment, 739 (10·3%) as probable dementia, and 1533 (21·3%) as cognitive loss. The incidence rates per 1000 person-years were 15·3 cases (95% CI 14·4-16·2) for mild cognitive impairment, 9·7 cases (9·0-10·4) for probable dementia, and 20·3 (19·3-21·3) for cognitive loss. Elevated SBP and PP were significantly associated with increased risk of mild cognitive impairment and cognitive loss (test for trends across SBP and PP strata, p<0·01). Individuals with hypertension, but with controlled SBP of less than 120 mm Hg did not have a significantly increased risk of mild cognitive impairment (HR 1·33, 95% CI 0·98-1·82, p=0·071), and of cognitive loss (1·09, 0·82-1·44, p=0·57) compared with normotension. Individuals on anti-hypertensive treatment with PP of less than 50 mm Hg did not have a significantly higher risk of mild cognitive impairment (1·26, 0·98-1·62, p=0·07) and of cognitive loss (1·17, 0·94-1·46, p=0·16). There were no significant associations between hypertension, SBP, or PP and probable dementia. INTERPRETATION Results of our study show significant associations of hypertension and elevated SBP and PP levels with risk of mild cognitive impairment and the combined endpoint of either mild cognitive impairment or probable dementia, suggesting that intensive control of hypertension, SBP, and PP can preserve cognitive health in older women. FUNDING National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Kathleen M Hayden
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Nathalie S May
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Bernhard Haring
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Zuolu Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Victor W Henderson
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Jiu-Chiuan Chen
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Edward J Gracely
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
| | - Stephen R Rapp
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD)
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9
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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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10
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de Heus RA, Tzourio C, Lee EJL, Opozda M, Vincent AD, Anstey KJ, Hofman A, Kario K, Lattanzi S, Launer LJ, Ma Y, Mahajan R, Mooijaart SP, Nagai M, Peters R, Turnbull D, Yano Y, Claassen JA, Tully PJ. Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis. Hypertension 2021; 78:1478-1489. [PMID: 34538105 PMCID: PMC8516811 DOI: 10.1161/hypertensionaha.121.17797] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Rianne A.A. de Heus
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
| | - Christophe Tzourio
- Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.)
| | - Emily Jo Lynn Lee
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Melissa Opozda
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia
| | - Andrew D. Vincent
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Kaarin J. Anstey
- School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia
| | - Albert Hofman
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.)
| | - Lenore J. Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.)
| | - Yuan Ma
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
| | - Rajiv Mahajan
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
- Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.)
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
- Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia
- University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia
- School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.)
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.)
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.)
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.)
- Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.)
- Imperial College London, United Kingdom (R.P.)
- Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.)
- The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Simon P. Mooijaart
- University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.)
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.)
| | - Ruth Peters
- Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia
- Imperial College London, United Kingdom (R.P.)
| | - Deborah Turnbull
- School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
| | - Yuichiro Yano
- Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.)
- The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.)
| | - Jurgen A.H.R. Claassen
- Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.)
| | - Phillip J. Tully
- Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia
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11
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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: 17] [Impact Index Per Article: 5.7] [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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12
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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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13
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de Heus RAA, Reumers SFI, van der Have A, Tumelaire M, Tully PJ, Claassen JAHR. Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population. J Alzheimers Dis 2021; 74:463-472. [PMID: 32039855 PMCID: PMC7175928 DOI: 10.3233/jad-191134] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated. OBJECTIVE To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients. METHODS We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0-4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP. RESULTS For 82 patients (aged 71.2±7.9 years), mean home BP was 140/79±15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04-1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. CONCLUSION Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.
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Affiliation(s)
- Rianne A A de Heus
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Stacha F I Reumers
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Alba van der Have
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Maxime Tumelaire
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | | | - Jurgen A H R Claassen
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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14
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Alateeq K, Walsh EI, Cherbuin N. Higher Blood Pressure is Associated with Greater White Matter Lesions and Brain Atrophy: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:637. [PMID: 33562359 PMCID: PMC7915964 DOI: 10.3390/jcm10040637] [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] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To summarise and quantify the evidence on the association between Blood pressure (BP), white matter lesions (WMLs), and brain volumes. METHOD Electronic databases PubMed, Scopus, and Clarivate were searched in February 2020 using an established methodology and pre-determined search terms. Studies were eligible for inclusion if they reported on the association between BP and WMLs or brain volume in cognitively healthy individuals, while adjusting for age and intra-cranial volume. RESULTS Searches yielded 7509 articles, of which 52 (26 longitudinal and 33 cross-sectional), were eligible and had a combined sample size of 343,794 individuals. Analyses found that 93.7% of studies reported that higher BP was associated with poorer cerebral health (higher WMLs and lower brain volumes). Meta-analysis of compatible results indicated a dose-dependent relationship with every one standard deviation increase in systolic BP (SBP) above 120 mmHg being associated with a 11.2% (95% CI 2.3, 19.9, p = 0.0128) increase in WMLs and -0.13% (95% CI -0.25, -0.023, p = 0.0183) smaller hippocampal volume. CONCLUSION The association between BP and brain volumes appears across the full range of BP measurements and is not limited to hypertensive individuals. Higher BP in community-residing individuals is associated with poorer cerebral health.
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Affiliation(s)
- Khawlah Alateeq
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT 2601, Australia; (E.I.W.); (N.C.)
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15
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Ma Y, Tully PJ, Hofman A, Tzourio C. Blood Pressure Variability and Dementia: A State-of-the-Art Review. Am J Hypertens 2020; 33:1059-1066. [PMID: 32710605 DOI: 10.1093/ajh/hpaa119] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
Accumulating evidence demonstrates that blood pressure variability (BPV) may contribute to target organ damage, causing coronary heart disease, stroke, and renal disease independent of the level of blood pressure (BP). Several lines of evidence have also linked increased BPV to a higher risk of cognitive decline and incident dementia. The estimated number of dementia cases worldwide is nearly 50 million, and this number continues to grow with increasing life expectancy. Because there is no effective treatment to modify the course of dementia, targeting modifiable vascular factors continues as a top priority for dementia prevention. A clear understanding of the role of BPV in dementia may shed light on the etiology, early prevention, and novel therapeutic targets of dementia, and has therefore gained substantial attention from researchers and clinicians. This review summarizes state-of-art evidence on the relationship between BPV and dementia, with a specific focus on the epidemiological evidence, the underlying mechanisms, and potential intervention strategies. We also discuss challenges and opportunities for future research to facilitate optimal BP management and the clinical translation of BPV for the risk assessment and prevention of dementia.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
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16
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Nagai M, Dote K, Kato M. How does dementia interact with visit-to-visit blood pressure variability and hip fracture? Osteoporos Int 2019; 30:1321-1322. [PMID: 30937484 DOI: 10.1007/s00198-019-04953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- M Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan.
| | - K Dote
- Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - M Kato
- Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
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