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Visit-to-visit blood pressure variations: new independent determinants for cognitive function in the elderly at high risk of cardiovascular disease

Nagai, Michiakia,b; Hoshide, Satoshia; Ishikawa, Jojia; Shimada, Kazuyukia; Kario, Kazuomia

Journal of Hypertension:
doi: 10.1097/HJH.0b013e3283552735
ORIGINAL PAPERS: BP measurement
Abstract

Objective: Recently, visit-to-visit blood pressure (BP) variability has been shown to be associated with silent cerebral injury and stroke. However, the relationships between visit-to-visit BP variation and cognitive function are not clear.

Methods: The cognitive function was evaluated using a mini-mental state examination (MMSE) and global deterioration scale (GDS) in 201 elderly patients at high risk of cardiovascular disease (CVD) (79.9 ± 6.4 years old; women 75%). Based on 12 visits (once a month), visit-to-visit BP variability (expressed as the SD and coefficient of variation), maximum BP, minimum BP, and δ (maximum − minimum) BP were measured.

Results: The MMSE score had significant negative correlations with coefficient of variation and δ in SBP, and δDBP. The GDS score had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. Low MMSE score (<24) had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. High GDS score (>3) had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. In a multiple linear regression analysis adjusted for confounders, coefficient of variation (P < 0.001) and δ (P < 0.001) in SBP had significant negative associations with the MMSE score. The δSBP (P < 0.05) had significant positive association with the GDS score. The coefficient of variation and δ in SBP had significant positive associations with low MMSE score (P < 0.01, P < 0.01, respectively) and high GDS score (P < 0.05, P < 0.001, respectively).

Conclusions: In the high-risk elderly, exaggerated visit-to-visit BP fluctuations were significant indicators for cognitive impairment.

Author Information

aDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi

bShobara City Soryo Clinic, Shimoryoke, Soryo, Shobara, Hiroshima, Japan

Correspondence to Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji 3311–1, Shimotsuke, Tochigi 329–0498, Japan. Tel: +81 285 58 7538; fax: +81 285 44 4311; e-mail: kkario@jichi.ac.jp

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CCA, common carotid artery; CCB, calcium channel blockade; DM, diabetes mellitus; GDS, global deterioration scale; HDL, high-density lipoprotein; IMT, intima–media thickness; LDL, low-density lipoprotein; MMSE, mini-mental state examination

Received 30 August, 2011

Revised 13 December, 2011

Accepted 24 April, 2012

© 2012 Lippincott Williams & Wilkins, Inc.