Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis

Rianne A A de Heus¹, Christophe Tzourio², Emily Jo Lynn Lee³, Melissa Opozda^{3

4}, Andrew D Vincent³, Kaarin J Anstey^{5

6}, Albert Hofman⁷, Kazuomi Kario⁸, Simona Lattanzi⁹, Lenore J Launer¹⁰, Yuan Ma⁷, Rajiv Mahajan, Simon P Mooijaart^{11

12}, Michiaki Nagai¹³, Ruth Peters^{14

15}, Deborah Turnbull¹⁶, Yuichiro Yano^{17

18}; VARIABLE BRAIN Consortium; Jurgen A H R Claassen¹, Phillip J Tully³

Affiliations

¹ Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.).
² Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.).
³ Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia.
⁴ Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia.
⁵ School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia.
⁶ Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia.
⁷ Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.).
⁸ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.).
⁹ Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.).
¹⁰ Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.).
¹¹ University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia.
¹² Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.).
¹³ Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.).
¹⁴ Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia.
¹⁵ Imperial College London, United Kingdom (R.P.).
¹⁶ School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia.
¹⁷ Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.).
¹⁸ The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.).

PMID: 34538105
PMCID: PMC8516811
DOI: 10.1161/HYPERTENSIONAHA.121.17797

Meta-Analysis

Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis

Rianne A A de Heus et al. Hypertension. 2021 Nov.

. 2021 Nov;78(5):1478-1489.

doi: 10.1161/HYPERTENSIONAHA.121.17797. Epub 2021 Sep 20.

Authors

Affiliations

¹ Radboud University Medical Center, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., J.A.H.R.C.).
² Bordeaux Population Health, Univeristy of Bordeaux, Inserm, Team Healthy, UMR 1219, CHU Bordeaux, France (C.T.).
³ Adelaide Medical School (E.J.L.L., M.O., A.D.V., P.J.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia.
⁴ Centre for Nutrition and Gastrointestinal Research (M.O.), South Australian Health and Medical Research Institute, Australia.
⁵ School of Psychology (K.J.A.), University of New South Wales, Sydney, Australia.
⁶ Neuroscience Research Australia (K.J.A.), University of New South Wales, Sydney, Australia.
⁷ Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (A.H., Y.M.).
⁸ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.).
⁹ Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.).
¹⁰ Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.).
¹¹ University of Adelaide, Lyell McEwin Hospital (R.M.), South Australian Health and Medical Research Institute, Australia.
¹² Department of Gerontology and Geriatrics, Leiden University Medical Center, Institute for Evidence-Based Medicine in Old Age, the Netherlands (S.P.M.).
¹³ Department of Cardiology, Hiroshima City Asa Hospital, Japan (M.N.).
¹⁴ Neuroscience Research Australia (R.P.), University of New South Wales, Sydney, Australia.
¹⁵ Imperial College London, United Kingdom (R.P.).
¹⁶ School of Psychology (D.T.), Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Australia.
¹⁷ Yokohama City University Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Japan (Y.Y.).
¹⁸ The Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.).

PMID: 34538105
PMCID: PMC8516811
DOI: 10.1161/HYPERTENSIONAHA.121.17797

Abstract

[Figure: see text].

Keywords: Alzheimer disease; blood pressure; cerebrovascular disorders; dementia; hemodynamics; meta-analysis; stroke.

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Figures

**Figure 1.**
**Flow diagram of included studies.** BPV indicates blood pressure variability; and CI, cognitive impairment.

**Figure 2.**
**Schematic overview of included studies for the primary analysis.** X axis represents time in years and each study is presented at the mean age of the study population at baseline. Chuang et al (2016) and Matsumoto et al (2018) are missing from this overview because these studies (abstract only) did not report the mean age of the study population. A indicates ambulatory blood pressure measurements (24-h); H, home blood pressure measurements; S, single-visit (within-visit BP variability); and V, visit-to-visit variability (number presents number of visits.

**Figure 3.**
**Association of blood pressure(variability) (BP(V)) with dementia and cognitive impairment following multilevel meta-analysis.** Odds ratio (OR) for mean blood pressure is presented by 10 (systolic) or 5 (diastolic) mm Hg. OR for BPV is presented per 1-unit change in the BPV metric. ^aEffect size reported separately for group with and without vascular risk factors or disease. ^bEffect sizes reported separately for young and old group.

**Figure 4.**
**Bubble plots of meta-regression result for mean blood pressure (BP) as covariate.** The size of the bubble reflects the weight of the study. Line represents fitted meta-regression line. BPV indicates BP variability.

See this image and copyright information in PMC

References

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Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis

Affiliations

Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis

Authors

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Abstract

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Medical