Blood pressure variability (BPV) in older adults, particularly men, is associated with an increased risk of dementia and cognitive decline.
Blood pressure variability (BPV) in older adults, particularly men, is associated with an increased risk of dementia and cognitive decline, a new report from the long-term ASPirin in Reducing Events in the Elderly (ASPREE) study has revealed.
While hypertension in mid-life has previously been identified as a strong predictor of dementia in later life, recent data has suggested that more granular short and long-term fluctuations in blood pressure (BPV) are also an indicator of cognitive decline.
However, studies investigating BPV have typically involved younger people, older people already diagnosed with cognitive impairment, or used a single cognitive assessment tool to gauge cognitive acuity.
As such, researchers led by Associate Professor Joanne Ryan from the Monash School of Public Health and Preventive Medicine aimed to use the ‘uniquely suited’ ASPREE dataset to provide a ‘robust answer’ to the theory.
‘[In the study] a large cohort of participants underwent standardised blood pressure and cognition assessments, and they received long-term follow up,’ Associate Professor Ryan said.
‘Importantly, rather than just a single cognitive assessment tool, participants underwent a series of cognitive tests. This enabled us to capture detail on many facets of cognition and memory, including global cognition, delayed episodic memory, verbal fluency, and processing speed and attention.
‘They also underwent a validated depression scale prior to each annual cognitive test, which is important because depression may have an impact on cognitive function.’
Data from 16,758 participants were included in the study, which involved researchers grouping participants at baseline (study entry) into three groups, based on BPV: low, medium and high. BPV was generally higher among women than men, but cognitive scores were similar across participants with low, medium and high BPV.
However, differences emerged over time; those in the highest BPV group were shown to be at significantly increased risk of incident dementia and cognitive decline compared with those in the lowest BPV group, while being male also increased the risk significantly.
And even though men also have a higher lifetime exposure than women to other known risk factors of cognitive decline, such as uncontrolled high blood pressure and smoking, the increased risk for men remained even when this was taken into account by the researchers.
Associate Professor Ryan says further study is needed to help determine the underlying reasons for the sex-specific differences, as is research into whether reducing BPV can preserve late-life cognitive function
‘While we don’t know for sure, it is tempting to speculate about the existence of different pathways towards cognitive decline in men and women,’ she said. ‘Or sex hormones such as oestrogen across a woman’s lifetime may have a protective effect for women.’
Associate Professor Ryan also said that ‘any opportunity’ to identify risk early and engage people in preventive therapies is ‘important’.
‘By around 2050 we believe that people aged 60 years and older will outnumber adolescents and youths,’ she said.
‘As an age‐related disease, and one with a notable lack of treatments, dementia will indefinitely remain a major public health priority.’