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Association between blood pressure control status, visit-to-visit blood pressure variability, and cognitive function
Luxinyi Xu1,2, Ying Yang1,2, Dan Cui1,2
1School of Public Health, Wuhan University, Wuhan, China.
Insights
Maintaining stable blood pressure (BP) in late life and controlling hypertension are crucial for preserving cognitive function in the elderly. Visit-to-visit BP variability, especially systolic BP, significantly impacts cognitive domains like orientation and language.
Area of Science:
- Gerontology
- Neuroscience
- Cardiovascular Medicine
Background:
- Cognitive decline is a significant concern in the elderly, impacting quality of life and healthcare costs.
- The precise relationship between blood pressure (BP) control, BP variability, and cognitive function in older adults requires further clarification.
Purpose of the Study:
- To investigate the association between baseline BP control status, visit-to-visit BP variability, and cognitive function in a Chinese elderly population.
- To differentiate the impact of midlife versus late-life BP parameters on cognitive outcomes.
Main Methods:
- Analysis of 3,511 participants from the China Health and Retirement Longitudinal Study over a 7-year period (2011-2018).
- BP measurements taken in 2011, 2013, and 2015; cognitive function assessed using the Mini-Mental State Exam in 2018.
- Participants categorized into mid-old (45-59 at baseline) and old-old (≥60 at baseline) groups; statistical analyses included univariate analysis and general linear models.
Main Results:
- Late-life BP control status demonstrated stronger associations with cognitive function than midlife BP.
- Controlled late-life hypertension was linked to higher cognitive scores in language, orientation, and total scores compared to uncontrolled or untreated groups.
- Midlife visit-to-visit systolic BP variability was associated with language function, while late-life variability affected orientation, recall, language, and total cognitive scores.
Conclusions:
- Both BP control status and visit-to-visit BP variability are significantly associated with cognitive function in Chinese elderly.
- Effective late-life antihypertensive treatment and stable systolic BP may help prevent cognitive impairment, particularly affecting orientation and language functions.
Background:
Cognitive function is a concern among the elderly, which is related to the quality of life, life expectancy, and economic burdens. The relationship between blood pressure (BP) control status, visit-to-visit BP variability, and cognitive function remains controversial.
Methods:
We aimed to explore the association between BP control status at baseline, visit-to-visit BP variability, and cognitive function. This study included 3,511 elderlies in the China Health and Retirement Longitudinal Study, covering four waves for 7-year follow-up (baseline 2011, 2013, 2015, and 2018). BP was measured in Wave 2011, 2013, and 2015. Cognitive function was measured by Mini-Mental State Exam in Wave 2018. Participants were divided into two groups: mid-old group for reflecting midlife BP and cognition (45-59 years at baseline but aged 60 or over in Wave 2018), and old-old group for reflecting late-life BP and cognition (aged 60 or over at baseline). We use univariate analysis and general linear model to analyze.
Results:
Late-life BP showed stronger associations with cognitive function than midlife BP. As to late-life BP control status, controlled hypertension group get higher cognitive score than uncontrolled hypertension group in language (adjusted β = -0.34, 95%CI -0.68 to 0.00), and untreated hypertension group in orientation (adjusted β = -0.41, 95%CI -0.72 to -0.11), language (adjusted β = -0.35, 95%CI -0.67 to -0.04), and total (adjusted β = -0.99, 95%CI -1.85 to -0.12). Regarding visit-to-visit BP variability, midlife visit-to-visit systolic blood pressure (SBP) variability was associated with language (adjusted β = -3.70, 95% CI -5.83 to -1.57), while late-life visit-to-visit SBP variability was associated with orientation (adjusted β = -2.99, 95% CI -4.84 to -1.14), recall (adjusted β = -1.69, 95% CI -2.89 to -0.48), language (adjusted β = -2.26, 95% CI -4.13 to -0.38), and total (adjusted β = -9.50, 95% CI -14.71 to -4.28); Midlife diastolic blood pressure (DBP) variability and pulse pressure (PP) variability showed a significant relationship with language (adjusted β = 3.25, 95% CI -1.31 to -5.19) and calculation (adjusted β = -0.26, 95% CI -0.47 to -0.04), respectively. No significant correlation was found between midlife BP control status, late-life visit-to-visit DBP variability, late-life visit-to-visit PP variability, and cognitive score. There was no significant correlation between BP and memory.
Conclusions:
BP control status and visit-to-visit BP variability were significantly related to cognitive function among the Chinese elderly. Receiving effective late-life antihypertensive treatment and keeping SBP stable might contribute to prevent the development of cognitive impairment and dementia, especially for orientation and language function.
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