Visit-to-visit blood pressure variability linked to cognitive decline, dementia

Blood pressure variability (BPV) from one visit to the next is associated with cognitive decline and even dementia, according to a new study published in Hypertension.

“The clinical relevance of BPV has not been considered until recently,” wrote lead author Laure Rouch, PhD, PharmD, Paris Descartes University in France, and colleagues. “However, over the past decade, higher BPV has been increasingly recognized as a predictor of clinical events, such as stroke, myocardial infarction and cardiovascular and all-cause mortality. BPV has also been associated with lower hippocampal volume, presence of cerebral microbleeds, cortical infarcts, and white matter hyperintensities.”

To learn more about the relationship between BPV and cognitive impairment, Rouch et al. explored data from more than 3,300 patients. All patients were 65 years old or older and 57% were female. Each patient underwent examinations every six months for a total of three years. BPV was determined using standard deviation, coefficient of variation, average real variability, successive variation, variation independent of mean and residual standard deviation. Cognitive function and dementia were determined using the Mini-Mental State Examination, a scoring system that covers orientation to time, orientation to place, language capabilities and other key factors.

Overall, 2.8% of the cohort developed dementia. Higher visit-to-visit systolic BPV, diastolic BPV and mean arterial pressure variability were all connected to both poor cognition and an increased dementia risk. Baseline blood pressure values were associated with poor cognition, but not an increased risk of dementia.

“Our results emphasize the importance of focusing not only on blood pressure values but also on visit-to-visit BPV that could be an even better marker to identify patients at risk for developing cognitive impairment and dementia,” the authors wrote, adding that “further studies are needed to assess whether controlling blood pressure instability could be a promising interventional target in preserving cognition among older adults.”

The full Hypertension study is available here.