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Published on: April 23, 2021
Relationship between blood pressure and cognitive impairment in elderly outpatients with cardiometabolic diseases
Joji Ishikawa1, Ayumi Toba1, Yoshiaki Tamura2
1Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Insights
Blood pressure impacts cognitive function in older adults with heart disease. Lower systolic blood pressure is linked to cognitive decline in hypertensive patients, while higher blood pressure is associated with dementia risk in non-hypertensive individuals.
Area of Science:
- Geriatric Medicine
- Cardiology
- Neurology
Background:
- Cardiometabolic diseases significantly impact the health and well-being of elderly populations.
- Blood pressure (BP) is a critical factor in cardiovascular health and has been implicated in cognitive function.
- Understanding the complex relationship between BP and cognition is essential for managing age-related cognitive decline.
Purpose of the Study:
- To investigate the association between high or low blood pressure (BP) and cognitive function in elderly outpatients with cardiometabolic diseases.
- To differentiate the BP-cognition relationship based on hypertension history and treatment status.
Main Methods:
- A cohort of 677 elderly outpatients with cardiometabolic diseases was assessed.
- Blood pressure was measured and cognitive function was evaluated using the Dementia Assessment Sheet for Community-based Integrated Care System-21 items (DASC-21), Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment Tool (MoCA).
- Statistical analyses included linear and logistic regression to determine associations between BP and cognitive scores, controlling for confounding factors.
Main Results:
- Systolic blood pressure (SBP) showed a linear relationship with the DASC-21 score (r = -0.122, P = 0.004).
- Lower SBP was significantly associated with poorer performance on the DASC-21, even after adjusting for confounders (B = -0.411 per 10 mmHg, P = 0.002).
- An MMSE score ≤23 was linked to higher SBP in patients without hypertension history, but to lower SBP in those with hypertension, on hypertensive medication, or with dyslipidemia.
Conclusions:
- Higher BP is associated with a greater prevalence of probable dementia in elderly individuals without a history of hypertension.
- In patients with hypertension, particularly those on medication and with comorbidities, lower BP is linked to probable dementia, often related to reduced activities of daily living (DASC-21).
- The findings highlight a complex, bidirectional relationship between BP and cognitive status in older adults with cardiometabolic conditions, underscoring the need for individualized BP management strategies.
Aim:
The aim of this study was to clarify the relationship between high or low blood pressure (BP) and cognitive function in elderly outpatients with cardiometabolic diseases.
Methods:
We evaluated the association between BP and the Dementia Assessment Sheet for Community-based Integrated Care System-21 items (DASC-21), Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment Tool (MoCA) (N = 677).
Results:
The patients' mean age was 79.2 ± 6.3 years (male 35.3%), and BP was 132.1 ± 18.1/73.5 ± 12.2 mmHg. Systolic BP (SBP) was linearly related to the DASC-21 score (r = -0.122, P = 0.004), but not to the MMSE score (P = 0.101) or MoCA score (P = 0.802). Multiple linear regression analysis showed that lower SBP was significantly related to the DASC-21 score, even after controlling for confounding factors (B = -0.411 per 10 mmHg; 95% confidence interval [CI], -0.673 to -0.149; P = 0.002). Moreover, logistic regression analysis showed that lower SBP was associated with DASC-21 ≥ 31 (odds ratio = 0.838 per 10 mmHg, P = 0.048). An MMSE score ≤23 was significantly associated with higher SBP in patients without a history of hypertension but with lower SBP in those with hypertension, those on hypertensive medication, and those with dyslipidemia.
Conclusion:
Higher BP was associated with a higher prevalence of probable dementia in those without a history of hypertension, even in late life. In those with hypertension and those taking antihypertensives with comorbidities of stroke or heart failure, lower BP was associated with probable dementia, which was largely dependent on reduced activities of daily living, as measured by the DASC-21 score. Geriatr Gerontol Int 2024; 24: 110-117.
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