Related Experiment Video
Updated: Jul 6, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Effect of blood pressure on mortality in patients with cognitive impairment: a prospective cohort study
YanChang Shang1, ShuHui Wang2, Chao Wei1
1Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Insights
Elderly individuals with cognitive impairment (CI) face higher mortality risks. Hypertension significantly amplifies these risks, particularly for cardiovascular disease (CVD) mortality, underscoring the need for blood pressure management in this population.
Area of Science:
- Gerontology and Geriatric Medicine
- Cardiovascular Health
- Neurology and Cognitive Science
Background:
- Cognitive impairment (CI) is a significant risk factor for mortality in the elderly population.
- The independent and combined effects of hypertension and CI on mortality remain incompletely understood.
- This study addresses the contentious relationship between hypertension and mortality in older adults with CI.
Purpose of the Study:
- To investigate the influence of hypertension on all-cause and cardiovascular disease (CVD)-specific mortality.
- To examine these effects in elderly individuals diagnosed with cognitive impairment.
- To analyze the synergistic impact of hypertension and CI on mortality outcomes in a prospective cohort.
Main Methods:
- Utilized data from 2,925 participants (aged 60+) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014.
- Mortality data (all-cause and CVD-specific) were tracked via National Death Index linkage until December 2019.
- Employed Kaplan-Meier survival analysis and Cox proportional hazards regression to calculate hazard ratios (HRs).
Main Results:
- Participants with CI had significantly higher risks of all-cause (HR 1.96) and CVD-specific mortality (HR 2.8).
- In participants with CI, hypertension further elevated all-cause mortality risk (HR 2.73) and CVD-specific mortality risk (HR 5.3).
- The combined impact of hypertension and CI on mortality was more pronounced in younger elderly individuals (60-69 years).
Conclusions:
- Cognitive impairment substantially increases mortality risk, especially when co-occurring with hypertension.
- Hypertension exacerbates both all-cause and CVD-specific mortality in older adults with CI.
- Effective hypertension management is crucial for mitigating excess mortality risk in individuals with cognitive impairment.
Background:
Cognitive impairment is a prevalent condition that substantially elevates mortality rates among the elderly. The impact of hypertension on mortality in older adults with cognitive impairment is a subject of contention. This study aims to examine the influence of hypertension on both all-cause and CVD-specific mortality in elderly individuals experiencing cognitive impairment within a prospective cohort.
Methods:
This study encompassed 2,925 participants (weighted 53,086,905) aged 60 years or older from National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014. Incidence of all-cause and CVD-specific mortality was ascertained through linkage with National Death Index records until 31 December 2019. Survival was performed employing the Kaplan-Meier method. Hazard ratios (HRs) were calculated via Cox proportional hazards regression models.
Results:
Over the follow-up period of up to 9.17 years [with a median (IQR) time to death of 6.58 years], equivalent to 18,731.56 (weighted 3.46 × 108) person-years, there were a total of 576 recorded deaths. Participants with CI exhibited a 1.96-fold higher risk of all-cause mortality (95% CI: 1.55-2.49; p < 0.01) and a 2.8-fold higher risk of CVD-specific mortality (95% CI: 1.83-4.29; p < 0.01) in comparison to participants without CI. Among participants with CI, concurrent hypertension comorbidity was linked to a 2.73-fold elevated risk of all-cause mortality (95% CI: 1.78-4.17; p < 0.01) and a 5.3-fold elevated risk of CVD-specific mortality (95% CI: 2.54-11.04; p < 0.01). Further stratified analyses revealed that the combined effects of hypertension and CI on all-cause and CVD-specific mortality were more pronounced in participants aged 60-69 years compared to those aged 70-80 years (p for interaction <0.01). The primary findings exhibited resilience across a series of sensitivity analyses.
Conclusions:
Participants with CI exhibited a markedly elevated risk of all-cause and CVD-specific mortality when coexisting with hypertension. Appropriate management of hypertension in patients with CI may be helpful in reducing the excess risk of death.
More Related Videos
Related Concept Videos
01:28Factors affecting Blood pressure
Physiological Factors:
01:25Errors occurring during blood pressure monitoring
Several factors...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:30Cognitive Development During Adulthood
01:17Measurement of Blood Pressure
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.