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. 2023 Sep 1:5:100181.
doi: 10.1016/j.cccb.2023.100181. eCollection 2023.

Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults

D S Gutteridge  1 , P J Tully  2 , A E Smith  3 , T Loetscher  1 , H A Keage  1
Affiliations

Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults

D S Gutteridge et al. Cereb Circ Cogn Behav. .

Abstract

Background: High blood pressure variability (BPV), particularly in older age, appears to be an independent risk factor for incident dementia. The current study aimed to investigate the association between different BPV measures (short- and mid-term BPV including circadian patterns) and cognitive functioning as well as vascular stiffness measures to better understand the role that BPV plays in cognitive impairment.

Methods: 70 older adults (60-80-year-olds) without dementia completed a cognitive test battery and had their blood pressure (BP) assessed via a 24-hour ambulatory BP monitor (divided into sleep and wake for short-term BPV) and 4-day morning and evening home-based BP monitor (for day-to-day BPV). Arterial stiffness was evaluated via pulse wave analysis and pulse wave velocity (PWV) and cerebrovascular pulsatility was assessed via transcranial doppler sonography of the middle cerebral arteries.

Results: High systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, independent of the mean BP. Higher short-term BPV was associated with poorer attention and psychomotor speed, whilst day-to-day BPV was negatively linked with executive functioning. Circadian BP patterns (dipping and morning BP surge) showed no significant relationships with cognition after adjusting for covariates. Higher systolic short-term BPV was associated with higher arterial stiffness (PWV) and higher diastolic day-to-day BPV was linked with lower arterial stiffness. No significant associations between BPV measures and cerebrovascular pulsatility were present.

Conclusion: High BPV, independently of the mean BP, is associated with lower cognitive performance and increased arterial stiffness in older adults without clinically-relevant cognitive impairment. This highlights the role of systolic and diastolic BPV as a potential early clinical marker for cognitive impairment.

Keywords: CANTAB; aging; dementia; pulse wave velocity; transcranial doppler sonography.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Fig. 1
Study procedure by visits. ABPM Ambulatory blood pressure monitor, BP Blood pressure, BPV Blood pressure variability, CANTAB Cambridge Neuropsychological Test Automated Battery, TCD Transcranial doppler sonography, PWA Pulse wave analysis, PWV Pulse wave velocity, 3MS Modified Mini-Mental State examination.
Figure 2
Fig. 2
Spearman correlations between blood pressure variability (BPV) measures and cognitive measures, with the colour indicating the correlation coefficient r. * Indicates significant correlations (p<0.05). ARV Average real variability, CV Coefficient of variation, SBP systolic blood pressure, DBP diastolic blood pressure, MTT Multitasking test, PAL Paired associate learning, RTI Reaction time task, rt reaction time, RVP Rapid visual information processing, SWM Spatial working memory.
Figure 3
Fig. 3
Spearman correlations between systolic and diastolic blood pressure (BP) measures and vascular stiffness measure, with the colour illustrating the correlation coefficient r. ARV Average real variability, aix Augmentation index, CV Coefficient of variation, SBP systolic blood pressure, DBP diastolic blood pressure, PI Pulsatility index, pwv pulse wave velocity, TCD Transcranial Doppler.
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