Blood Pressure Postural Changes Variability Is Associated With Lower Cognition: The S.AGES Cohort.

Abstract

Background: Over the past decade, higher blood pressure (BP) variability and postural changes in BP have been associated with lower cognitive function. However, only one study has investigated the specific association between BP postural changes variability and brain health, showing a greater risk of dementia with higher systolic BP (SBP) postural changes variability. We aimed to investigate the association between BP postural changes variability and cognitive function in community-dwelling older adults.

Methods: Participants from the S.AGES (Sujets ÂGES) cohort underwent clinical examinations every 6 months during 3 years. At each clinical visit, an orthostatic SBP ratio was calculated: (seated SBP/standing SBP)×100. A similar method was used to compute an orthostatic diastolic BP ratio. Then, we assessed the visit-to-visit BP postural changes variability according to several indicators including coefficient of variation. Cognition was evaluated annually using the Mini-Mental State Examination. Statistical analyses were performed with linear mixed models.

Results: We included 2974 patients (mean age, 78 years). After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/diastolic BP, and BP-lowering treatment, visit-to-visit SBP postural changes variability was significantly associated with lower cognition (per 1-SD increase in coefficient of variation: adjusted β=-0.15 [95% CI, -0.27 to -0.04], P=0.01). Similar results were found with visit-to-visit diastolic BP postural changes variability.

Conclusions: Visit-to-visit SBP and diastolic BP postural changes variability were associated with lower cognition. Further studies are needed to assess whether controlling orthostatic BP instability over time could help preserve cognitive function.

Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01065909.