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Cumulative Blood Pressure As Risk Factor For Cognitive Decline and Dementia

MedicalResearch.com Interview with:
Dr. Yangfeng Wu

Peking University Clinical Research Institute
Peking University

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: It is well-established that elevated blood pressure (BP) at single time point can contribute to increased risks of suffering accelerated cognitive decline, dementia, and mortality. Nevertheless, BP levels could experience significant alterations as time goes, indicating the necessity of monitoring BP longitudinally. In other words, using blood pressure levels measured at baseline to predict future outcomes in a longitudinal cohort with a long-term follow-up period ≥20 years, becomes controversial. Cumulative BP levels have been indicated as a feasible approach for evaluating long-term exposure of BP levels, which might have the ability to respond to this controversy.

This is the main reason why we performed this research to evaluate the predictive values of cumulative BP levels, especially additional values beyond baseline blood pressure levels, for future neurocognitive and longevity outcomes.

MedicalResearch.com:  What are the main findings?

Response: Based on 12-year survey data from the Health and Retirement Study (HRS) and 20-year data from English Longitudinal Study of Ageing (ELSA), we found that elevated cumulative systolic BP and pulse pressure were independently associated with accelerated cognitive decline, elevated dementia risk, and all-cause mortality, while a significant inverse association was observed for diastolic BP. When further adjusting for blood pressure at single time point (baseline), the observed associations remained significant.

Also, we found that further adjusting for cumulative systolic BP did not bring substantial changes to results of cumulative pulse pressure. These findings indicated that the cumulative BP could possess additional predictive utilities than single time BP, and cumulative pulse pressure could predict neurocognitive and longevity outcomes independently from cumulative systolic blood pressure.

MedicalResearch.com: What should readers take away from your report?

Response: Monitoring blood pressure longitudinally could have important clinical significance. For cognitively healthy middle-aged and older individuals, efforts may be required to control long-term systolic blood pressure and simultaneously maintain adequate diastolic BP, with additional attention on controlling long-term PP warranted. This could be beneficial to both neurocognition and longevity. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research could work on developing new risk prediction tools that incorporate the cumulative blood pressure as an independent risk predictor for major neurocognitive disorders, including dementia and Alzheimer’s disease. More importantly, efforts are warranted on developing effective strategies of controlling long-term BP and identifying the potential optimal threshold.

No disclosures

Citation:

Li C, Zhu Y, Ma Y, et al. Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality. J Am Coll Cardiol. 2022 Apr, 79 (14) 1321–1335.https://doi.org/10.1016/j.jacc.2022.01.045

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Apr 5, 2022 @ 9:50 pm

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