Strict Systolic Blood Pressure Control Might Impact Cognition In Elderly Interview with:
Dr. Enrico Mossello

Research Unit of Medicine of Ageing
Department of Experimental and Clinical Medicine
University of Florence

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

Dr. Mossello: In spite of the high prevalence of high blood pressure (HBP) and cognitive impairment in old age, their relationship is still controversial. While several (but not all) studies have identified high blood pressure as a risk factor for incident cognitive impairment, evidence regarding the prognostic role of blood pressure in cognitively impaired older subjects is scarce and inconsistent. To our knowledge, no longitudinal study has been published up to now regarding Ambulatory Blood Pressure Monitoring (ABPM) in subjects with cognitive impairment. Moreover recent European and American guidelines on HBP leave decisions on antihypertensive therapy of frail elderly patients to the treating physician and do not provide treatment targets for cognitively impaired patients.

In the present cohort study of subjects with dementia and Mild Cognitive Impairment (MCI) low values of day-time systolic blood pressure measured with ABPM were associated with greater progression of cognitive decline after a median 9-month follow-up. This association was limited to subjects treated with anti-hypertensive drugs and was independent of age, vascular comorbidity and baseline cognitive level, holding significant both in dementia and in Mild Cognitive Impairment subgroups. A similar trend of association was observed for office systolic blood pressure, although this was weaker and did not reach statistical significance in all analyses.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Mossello: Antihypertensive treatment with strict control of SBP (<130 mmHg) in older outpatients with Mild Cognitive Impairment and dementia might negatively affect cognition in the short-term. Taking into account cardiovascular protective effect in the long term, daytime SPB of 130-145 mmHg might be the most appropriate therapeutic target in this population according to available data. ABPM can be useful to make appropriate decisions regarding antihypertensive treatment in cognitively impaired subjects with mildly elevated SBP values.

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

Dr. Mossello: Longitudinal ABPM studies of larger samples with longer follow-up time are needed to confirm possible negative effects of excessive blood pressure lowering in cognitively impaired older subjects and to evaluate the long-term prognostic effects of blood pressure values in older subjects with cognitive impairment. Randomized controlled trials would be welcome in order to assess risks and benefits of antihypertensive treatment with different targets in this peculiar population.

Citation: Interview with: Dr. Enrico Mossello (2015). Strict Systolic Blood Pressure Control Might Impact Cognition In Elderly