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Associations of Blood Pressure Trajectories with Subsequent Cognitive Decline, Dementia and Mortality
1Wuxiang Xie, Peking University Clinical Research Institute, Peking University First Hospital, No. 38 Xueyuan Road, Haidian District, 100191, Beijing, China. Telephone: +86-10-82805564-622; Fax: +86-10-62015547; E-mail: xiewuxiang@hsc.pku.edu.cn; Fanfan Zheng, Department of Clinical Nursing, School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba Da Chu Rd, Shijingshan District, 100144, Beijing, China.
Insights
Long-term high systolic blood pressure (SBP) and low diastolic blood pressure (DBP) trajectories are linked to cognitive decline, dementia, and mortality. Managing blood pressure patterns is key for cognitive health and longevity.
Area of Science:
- Gerontology
- Cardiovascular Health
- Neuroscience
Background:
- Hypertension is a known risk factor for cognitive impairment.
- Longitudinal associations between blood pressure (BP) patterns and cognitive decline remain unclear, particularly for diastolic BP (DBP).
Purpose of the Study:
- To investigate the long-term trajectories of systolic BP (SBP) and DBP.
- To examine the relationship between these BP trajectories and subsequent cognitive decline, dementia incidence, and all-cause mortality in a general population.
Main Methods:
- A population-based cohort study of 7566 participants from the English Longitudinal Study of Ageing (ELSA).
- BP measurements were taken in 1998, 2004, and 2008.
- Group-based trajectory modeling identified distinct SBP and DBP patterns, followed by 10-year outcome assessments for cognition, dementia, and mortality.
Main Results:
- Five distinct SBP and DBP trajectories were identified.
- Both high-stable SBP (180 mmHg) and low-stable DBP (60 mmHg) trajectories were independently associated with faster cognitive decline.
- High-stable SBP significantly increased dementia risk (HR 4.79), while low and moderate-low stable DBP trajectories also elevated dementia risk (HRs 1.58 and 1.56, respectively).
- Similar associations were observed between BP trajectories and all-cause mortality.
Conclusions:
- Different blood pressure trajectories have distinct health impacts.
- Controlling long-term SBP and maintaining adequate DBP are crucial for promoting cognitive health.
- These findings suggest that personalized management of BP patterns may be vital for enhancing cognitive function and extending lifespan.
Background:
Hypertension may harm cognitive performance, but the potential correlates of longitudinal patterns of blood pressure (BP), especially diastolic BP (DBP), to cognition have been unclear.
Objectives:
To examine long-term BP trajectories in relation to subsequent cognitive decline, incident dementia and all-cause mortality in the general population.
Design:
Population-based cohort study.
Setting:
Communities in England.
Participants:
The study included 7566 participants from the English Longitudinal Study of Ageing (ELSA).
Measurements:
BP were measured in 1998, 2004, 2008. Group-based trajectory modeling was used to identify long-term patterns of systolic BP (SBP) and DBP. Outcomes including cognitive function, incident dementia, and all-cause mortality were followed up to 10 years.
Results:
Five distinct trajectories were identified for SBP and DBP, respectively. The normal-stable trajectory was used as the reference. For cognitive decline, both SBP and DBP trajectories were independently associated with subsequent cognitive decline, with the fastest decline appeared in the high-stable SBP group of 180 mmHg and the low-stable DBP group of 60 mmHg (both P<0.005). For incident dementia, the multivariable adjusted hazard ratio (HR) was also greatest in high-stable group (4.79, 95% confidence interval: 2.84 to 8.07) across all SBP trajectories. Conversely, low (HR: 1.58) and moderate-low stable (HR: 1.56) DBP trajectories increased dementia risk (both P<0.005). Similar patterns were found in BP trajectories in relation to all-cause mortality.
Conclusion:
Our study evaluates the potential health impact from different BP trajectories and suggests that controlling long-term SBP and maintaining adequate DBP may be relevant for the current practice to promote cognitive health and extend lifespan.
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