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Association Between ABPM Phenotypes and Cognitive Impairment in a Community-Dwelling, Older Adult Population Taking
Trevor Sproule1, Lana Sargent2,3, Elvin Price1,2
1Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, United States.
Insights
Hypertension is linked to cognitive impairment (CI). This study found that abnormal sleep blood pressure and heart rate patterns in older adults were associated with a higher prevalence of CI.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Hypertension (HTN) is a known risk factor for cognitive impairment (CI).
- Understanding the specific blood pressure monitoring phenotypes associated with CI is crucial, especially in diverse aging populations.
Purpose of the Study:
- To investigate the relationship between Ambulatory Blood Pressure Monitoring (ABPM) phenotypes and cognitive impairment (CI).
- To explore these associations in a study population primarily composed of Black, older adults with hypertension.
Main Methods:
- A cross-sectional study involving adults aged 60+ with HTN on antihypertensives.
- Utilized 24-hour ABPM and the Mini-Mental State Examination (MMSE-2) to assess BP control and CI.
- Defined non-dipping BP as a sleep BP decline of <10% and compared ABPM phenotypes with MMSE-2 results.
Main Results:
- Cognitive impairment (CI) was identified in 29% of participants.
- CI prevalence was significantly higher in those with a non-dipping BP pattern (75% vs. 40.8%).
- Elevated sleep diastolic BP and abnormal heart rate (24-hour, awake, sleep, seated) were also significantly associated with higher CI prevalence.
Conclusions:
- Sleep blood pressure and heart rate patterns are associated with a greater prevalence of cognitive impairment.
- These findings suggest potential pathophysiological links between BP regulation during sleep and CI.
- Further longitudinal studies in larger populations are warranted to confirm these associations.
Background:
Hypertension (HTN) is associated with an increased risk of cognitive impairment (CI). This study aimed to explore the relationship between Ambulatory BP Monitoring (ABPM) phenotypes and CI in a predominantly Black, older adult population.
Methods:
This cross-sectional study enrolled adults ≥60 years of age with HTN and taking ≥1 antihypertensive. Participants had 3 seated BP readings taken 1 minute apart, followed by 24-hour ABPM. Cognitive impairment was determined using the Mini-Mental State Examination (MMSE-2) with a cutoff score of ≤25. 24-hour ABPM control was defined as <125/75, and seated BP control was defined as <130/80 mm Hg. A sleep BP decline of <10% was used to identify non-dippers. ABPM phenotypes were compared to categorical data measured by the MMSE-2 and analyzed using the Chi-square test. Unadjusted and adjusted (age and gender) prevalence ratios were also calculated.
Results:
The 69 participants included in the analysis had a mean age of 69 years, 56.5% were female, and 73.9% identified as Black/African American. Cognitive impairment was identified in 29% (n = 20) of the participants according to their MMSE-2 score. Cognitive impairment prevalence was significantly higher among participants exhibiting a non-dipping BP pattern (75% vs 40.8%; P = .01), elevated sleep diastolic BP (P = .02), and 24-hour, awake, sleep, and seated heart rate (P < .05 for all).
Conclusions:
Sleep BP and heart rate were associated with a higher prevalence of CI and may offer clues as to the underlying pathophysiology of BP-associated CI. These findings warrant further study in a larger population followed longitudinally.
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