4C.07: RELATIONSHIPS BETWEEN COGNITIVE DYSFUNCTION, CLINIC AND AMBULATORY BLOOD PRESSURE AND BLOOD PRESSURE VARIABILITY. (June 2015)

• Record Type: Journal Article
• Authors: Trevano, F. Quarti; Bombelli, M.; Buzzi, S.; Facchetti, R.; Cuspidi, C.; Grassi, G.; Mancia, G.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000467501.75589.73
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The relation between blood pressure (BP) and cognitive function has received growing interest in recent years. Some cross-sectional studies have shown an inverse association between BP and cognitive dysfunction, while longitudinal studies yield mixed results. Design and method: In the PAMELA study cognitive function was assessed via minimental test at the evaluation performed in 2001–2002, taking as reference clinic data collected at the 1st PAMELA examination carried out 10 yrs before. 471 subjects participated at this substudy. Measurements included clinic and 24-hour BP (Spacelabs 90207). BP variability was obtained by calculating 1) the SD of 24-hour, day, and night mean values, 2) the day/night BP difference and (3) the residual or erratic BP variability (Fourier spectral analysis). Results: Mean age of the subjects enrolled was 63.0 ± 5.7 yrs (mean ± SD) at the 1St examination. At the 2nd evaluation performed 10 yrs later 26 subjects had a minimental score < 23, indicative of a cognitive dysfunction (CD), the remaining 445 showing normal scores (C, 24–30). For similar heart rate, office and home systolic (but not diastolic) BP were, although not significantly, greater in CD than in C (148.0 ± 22.5 vs 143.5 ± 19.9 and 139.5 ± 15.14 vs 133.3 ± 17.9 mmHg, P = NS). 24hour BP was similar in CD and C, this being the case also for 24 hour BP variability, expressed as SD systolic (15.3 ± 4.1 vs 14.8 ± 3.7 mmHg, P = NS) and diastolic (12.9 ± 3.47 vs 12.2 ± 2.9 mmHg, P = NS) or day/night BP difference. In contrast, residual BP variability was significantly greater in CD than in C for both systolic (11.2 ± 2.2 vs 10.6 ± 2.5 mmHg, P < 0.05) and diastolic (9.3 ± 2.1 vs 8.7 ± 2.3 mmHg, P < 0.05), the difference between groups being greater when the grading of minimental responses was based on 3 score categories (0–20, 21–24 and >24). This was particularly the case in males. Conclusions: Our data show that the most sensitive prognostic variable for the development of cognitive alterations does not appear to be absolute BP load or absolute BP variability but rather its short-term erratic component, which has been previously shown to represent the part of BP variability with major impact on cardiovascular mortality.