Optimal Blood Pressure Levels to Prevent Cognitive Decline in Older Adults
Observational study at the 26th European Meeting on Hypertension suggests maintaining high-normal levels of systolic blood pressure between 130-145 mmHg may reduce cognitive decline and mortality risk in older adults. The complex relation between blood pressure and cognitive impairment is explored, highlighting the need for further research in this area. Study design involved 198 patients, with a focus on clinic and ambulatory blood pressure monitoring to assess the association with dementia over three years. Tertiles of patients based on blood pressure levels were also analyzed during the conference.
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26thEuropean Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Optimal Blood Pressure Level to Prevent Cognitive Decline in Older Adults From ESH 2016 | POS 3C: Chiara Lorenzi, MD AOU, University of Florence, Italy Infomedica Conference Coverage* of 26thEuropean Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 * Infomedica is an independent medical education provider that produces medical information to healthcare professionals through conference coverage and online educational programs and activities. Powered by Infomedica
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Overview Observational study of older adults with cognitive impairment showed that high-normal levels of systolic blood pressure (SBP) of 130-145 mmHg may be the optimal target to reduce the progression of cognitive decline and reduce the risk of mortality at 3 years Relation between blood pressure and cognitive impairment complex Scarce and contradictory data on prognostic role of high blood pressure in this population Many studies demonstrated high blood pressure can increase dementia Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Study Design 198 patients included 135 patients had dementia at baseline, 68.9% had cognitive follow-up at baseline and 3 years Evaluated 3-year association between clinic blood pressure (CBP), ambulatory blood pressure monitoring (ABPM), and antihypertensive medications Patients divided into tertiles based on CBP and ABPM Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Tertiles of Patients By Clinic and Ambulatory Blood Pressure Clinical SBP Daytime SBP Nighttime SBP Tertiles 125 mmHg 128 mmHg 119 mmHg Lower 126-149 mmHg 129-144 mmHg 120-135 mmHg Average 150 mmHg 145 mmHg 136 mmHg Higher SBP, systolic blood pressure. Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Baseline Characteristics in Study of Cognitive Decline Total sample N=198 79 5 126 (63,6%) 121 (61,1%) 142 (71,7%) 1,5 1,2 136 (68,7%) 139,3 20,9 76,3 10,3 136,9 15,6 129,1 18,4 (n=185) 22,4 4,4 0,9 1,2 2,7 2,4 Cognitive follow-up N=135 79 5 92 (68,1%) 93 (68,9%) 98 (72,6%) 1,5 1,3 95 (70,4%) 137,4 19,9 76,1 10,5 135,6 15,0 126,2 17,1 (n=124) 21,8 4,6 0,9 1,2 3,0 2,5 Telephone follow-up N=63 79 5 34 (54,0%) 28 (44,4%) 44 (69,8%) 1,5 1,1 41 (65,1%) 143,3 22,5 76,6 10,0 139,6 16,6 135,1 19,7 (n=61) 23,6 3,8 0,9 1,4 2,4 2,2 Sample Age Female, n (%) Dementia High blood pressure Vascular comorbosity index Antihypertensive drugs Clinic SBP Clinic DBP Mean daytime SBP Mean night-time SBP MMSE Lost BADL Lost IADL BADL, basic activities of daily living; DBP, diastolic blood pressure; IADL, instrumental activities of daily living; MMSE, Mini Mental State Examination; SBP, systolic blood pressure. Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Results No association between clinic SBP and event rate across tertiles Higher rate of morality with higher mean nighttime SBP in treated (p=0.005) and untreated patients (p=0.008) Independent association, after adjustment for age, sex, functional status, and cognitive status Higher rate of mortality with higher mean daytime SBP, but not significant Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Results No association between cognitive outcomes and CBP Greater progression in cognitive decline with lower mean SBP (p=0.029) Similar trend for lower mean nighttime SBP, but not significant Independent association between lower daytime SBP and progression of cognitive decline (p=0.026), after adjustment Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Results Association between treatment and greater progression in cognitive decline with lower mean daytime SBP (p=0.002) and lower mean nighttime SBP (p=0.033), compared with those patients not treated Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Optimal Blood Pressure Level to Prevent Cognitive Decline in Older Adults From ESH 2016 | POS 3C: Chiara Lorenzi, MD AOU, University of Florence, Italy Infomedica Conference Coverage* of 26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 * Infomedica is an independent medical education provider that produces medical information to healthcare professionals through conference coverage and online educational programs and activities. Powered by Infomedica
