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Updated: Apr 18, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high
Michael Böhm1, Helmut Schumacher2, Darryl Leong2
1From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.). michael.boehm@uks.eu.
Insights
Systolic blood pressure variation and mean heart rate predict cognitive decline in high-risk patients. Monitoring these factors may help identify individuals susceptible to cognitive dysfunction.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Cardiovascular disease patients are at increased risk for cognitive decline.
- Systolic blood pressure (SBP) is a known risk factor for cognitive impairment.
- The impact of heart rate (HR) and blood pressure variability on cognition is less understood.
Purpose of the Study:
- To investigate the association between visit-to-visit SBP variation (SBP-CV) and mean HR with cognitive decline.
- To identify independent predictors of cognitive dysfunction in patients with cardiovascular disease.
Main Methods:
- Analysis of data from 24,593 patients without prior cognitive dysfunction.
- Assessment of cognitive function using the mini-mental state examination.
- Evaluation of mean SBP, SBP-CV, mean HR, and HR-CV over an average of 10.7 visits.
Main Results:
- Both SBP-CV and mean HR were independently associated with cognitive dysfunction, decline, and deterioration.
- Higher SBP-CV and mean HR levels correlated with increased odds of cognitive impairment.
- Additive effects were observed between SBP-CV and mean HR.
Conclusions:
- SBP-CV and mean HR are significant, independent predictors of cognitive decline and dysfunction.
- These cardiovascular parameters offer potential targets for early detection and intervention strategies.
- Monitoring SBP variability and HR may aid in managing cognitive health in high-risk populations.
Unlabelled:
Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.
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