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The association between blood pressure variability (BPV) with dementia and cognitive function: a systematic review and meta-analysis protocol

VARIABLE BRAIN consortium. Syst Rev. .

Abstract

Background: A body of empirical work demonstrates that wide fluctuations in a person's blood pressure across consecutive measures, known as blood pressure variability (BPV), hold prognostic value to predict stroke and transient ischemic attack. However, the magnitude of association between BPV and other neurological outcomes remains less clear. This systematic review aims to pool together data regarding BPV with respect to incident dementia, cognitive impairment, and cognitive function.

Methods: Electronic databases (MEDLINE, EMBASE, and SCOPUS) will be searched for the key words blood pressure variability and outcomes of dementia, cognitive impairment, and cognitive function. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: population-adult humans (over 18 years but with no upper age limit) without dementia at baseline, with or without elevated blood pressure, or from hypertensive populations (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or use of antihypertensive drug for hypertension) and from primary care, community cohort, electronic database registry, or randomized controlled trial (RCT); exposure-any metric of BPV (systolic, diastolic or both) over any duration; comparison-persons without dementia who do not have elevated BPV; and outcome-dementia, cognitive impairment, cognitive function at follow-up from standardized neurological assessment, or cognitive testing. Article screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, odds ratios, correlations, regression coefficients, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the neurological outcomes with Comprehensive Meta-Analysis Version 2.0 (Biostat Inc., Engelwood, NJ).

Discussion: This systematic review aims to clarify whether BPV is associated with elevated risk for dementia, cognitive impairment, and cognitive function. An evaluation of the etiological links between BPV with incident dementia might inform evidence-based clinical practice and policy concerning blood pressure measurement and hypertension management. The review will identify sources of heterogeneity and may inform decisions on whether it is feasible and desirable to proceed with an individual participant data meta-analysis.

Systematic review registration: PROSPERO CRD42017081977.

Keywords: Ambulatory blood pressure monitoring; Blood pressure variability; Cognitive impairment; Dementia; Etiology; Hypertension; Meta-analysis; Protocol; Systematic review.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval is not applicable to this protocol article.

Consent for publication

Not applicable.

Competing interests

Dr. Tully reports funding from the National Health and Medical Research Council of Australia (Neil Hamilton Fairley—Clinical Overseas Fellowship #1053578).

Prof. Anstey reports funding from the National Health and Medical Research Council of Australia Fellowship #1102694.

Dr. Mahajan is supported by Early Career Fellowship from the National Health and Medical Research Council (NHMRC) and National Heart Foundation (NHF) of Australia. Dr. Mahajan reports that the University of Adelaide receives on his behalf lecture and/or consulting fees from Abbott and Medtronic.

Prof. Seshadri reports that the Framingham Heart Study is supported by the following grants and contracts: NHLBI’s Framingham Heart Study (N01-HC-25195; HHSN268201500001I), NIA grants (R01 033193, U01 AG049505, R01 AG049607, R01 AG054076, U01 AG052409), and NINDS (R01NS017950, UH2 NS100605).

The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The other authors declare that they have no competing interests.

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