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Day-to-Day Blood Pressure Variability and Cognitive Function in the Elderly With Acute Heart Failure
Michiaki Nagai1,2, Keigo Dote2, Masaya Kato2
1Cardiovascular Section, Department of Medicine, University of Oklahoma Health Science Center, Oklahoma, USA.
American Journal of Hypertension
|March 11, 2025
Summary
High blood pressure variability in older adults with acute decompensated heart failure is linked to cognitive impairment, particularly in heart failure with preserved ejection fraction patients.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Heart failure (HF) and cognitive impairment frequently coexist in elderly individuals.
- While prior research suggests a link between blood pressure variability (BPV) and cognitive decline, the specific mechanisms in HF remain unclear.
- This study investigates the association between BPV and cognitive impairment in elderly patients experiencing acute decompensated heart failure (ADHF).
Purpose of the Study:
- To evaluate the hypothesis that elevated blood pressure variability (BPV) is associated with cognitive impairment in elderly patients with ADHF.
- To explore the relationship between different measures of BPV and cognitive function.
- To determine if this association differs across heart failure phenotypes.
Main Methods:
- Assessed day-to-day in-hospital blood pressure variability (BPV) and cognitive function using the Mini-Mental State Examination (MMSE) in 245 elderly patients with ADHF.
- Measured BPV over 7 days using standard deviation (SD), coefficient of variation (CV), maximum BP, minimum BP, and range (δ).
- Employed logistic regression analysis, adjusted for confounders, and stratified analysis by HF phenotypes.
Main Results:
- Significant differences in diastolic blood pressure (DBP) variability (SD, CV, δ) were observed across MMSE score quartiles.
- Higher DBP variability (SD, CV, maximum, δ) was significantly associated with lower MMSE scores after adjusting for confounders.
- The association between day-to-day DBP variability and lower cognitive function was particularly evident in patients with heart failure with preserved ejection fraction (HFpEF).
Conclusions:
- Cognitive impairment is increasingly prevalent in elderly patients with ADHF.
- Day-to-day blood pressure variability is significantly associated with cognitive impairment in this population.
- The association is specifically pronounced in patients with heart failure with preserved ejection fraction (HFpEF).
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