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Blood Pressure Parameters and Risk of Cognitive Decline and Dementia in Type 2 Diabetes: Results From the ADVANCE
Sultana Shajahan1, Mark Woodward1,2, Craig S Anderson1,3,4
1The George Institute for Global Health University of New South Wales Sydney NSW Australia.
Insights
Blood pressure variability and baseline pulse pressure, not BP load, are linked to increased dementia risk in type 2 diabetes patients. These factors may guide brain health preservation strategies.
Area of Science:
- Cardiology
- Neurology
- Endocrinology
Background:
- Blood pressure (BP) variability and load are linked to cardiovascular risk.
- Their association with cognitive decline/dementia, especially in type 2 diabetes, needs further investigation.
- Differences by baseline cognitive function and sex are not well understood.
Purpose of the Study:
- To investigate associations between different BP parameters and cognitive decline/dementia in type 2 diabetes patients.
- To explore potential differences in these associations based on mild cognitive impairment at baseline and sex.
Main Methods:
- Utilized data from the ADVANCE study (NCT00145925).
- Calculated BP parameters from an 18-month exposure window.
- Employed logistic regression to assess associations with cognitive decline or dementia diagnosis.
Main Results:
- Over 3.5 years, 17.5% of participants experienced cognitive decline/dementia.
- Higher BP variability and baseline pulse pressure (PP) were associated with increased odds of cognitive decline/dementia.
- No significant differences were observed based on mild cognitive impairment status or sex.
Conclusions:
- Elevated BP variability and baseline PP, not mean BP or BP load, correlate with higher odds of cognitive decline/dementia in type 2 diabetes.
- BP variability and PP may serve as crucial therapeutic markers for maintaining brain health.
Background:
Blood pressure (BP) variability and cumulative BP load are significantly associated with cardiovascular disease risk beyond mean systolic BP, but less is known regarding their associations with cognitive decline/dementia and whether these associations differ by cognitive function at baseline or by sex. The aims of this study were to determine associations of different BP parameters with cognitive decline/dementia in patients with type 2 diabetes and explore differences by mild cognitive impairment at baseline and sex.
Methods:
Using data from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) study, BP parameters were calculated from an 18-month exposure window comprising measurements at 3, 4, 6, 12, and 18 months, after randomization. Logistic regression was used to estimate the odds ratio (OR) per SD higher and 95% CI for the associations of BP parameters with the composite outcome of cognitive decline (≥3 points from baseline on the Mini-Mental State Examination) or clinical diagnosis of dementia.
Results:
Of the 11 140 ADVANCE participants, 9586 patients had 5 complete BP measurements within the 18-month exposure window. After a mean follow-up of 3.5 years, 1674 (17.5%) participants were diagnosed with cognitive decline and/or dementia. Overall, variability and baseline pulse pressure (PP), but not BP load, were associated with higher odds of cognitive decline/dementia (OR: variability in systolic BP, 1.11 [95% CI, 1.05-1.17]; diastolic BP, 1.11 [95% CI, 1.05-1.17]; PP, 1.05 [95% CI, 1.00-1.11]; mean arterial pressure, 1.13 [95% CI, 1.07-1.19]; and baseline PP, 1.19 [95% CI, 1.13-1.25]). There were no differences by mild cognitive impairment at baseline or sex.
Conclusions:
Higher BP variability and baseline PP, but not mean BP or BP load, were associated with higher odds of cognitive decline/dementia in patients with type 2 diabetes. BP variability and PP may be important therapeutic markers for the preservation of brain health.
Registration:
URL: https://clinicaltrials.gov; Unique Identifier: NCT00145925.
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