Abstract
Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85–87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = −0.36, p = 0.034) and diastolic BP (b = −0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.
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References
Prince M, Wimo A, Guerchet M, Ali GC, Wu YT, Prina M. World Alzheimer report 2015—the global impact of dementia: an analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International (ADI);2015.
Hu C, Yu D, Sun X, Zhang M, Wang L, Qin H. The prevalence and progression of mild cognitive impairment among clinic and community populations: a systematic review and meta-analysis. Int Psychogeriatr. 2017;29:1595–608.
Ritchie K, Lovestone S. The dementias. Lancet. 2002;360:1759–66.
Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42:2672–713.
Walker KA, Power MC, Gottesman RF. Defining the relationship between hypertension, cognitive decline, and dementia: a review. Curr Hypertens Rep. 2017;19:24.
Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JP, Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol. 2008;63:494–506.
Meng XF, Yu JT, Wang HF, Tan MS, Wang C, Tan CC, et al. Midlife vascular risk factors and the risk of Alzheimer's disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;42:1295–310.
Nagai M, Hoshide S, Dote K, Kario K. Visit-to-visit blood pressure variability and dementia. Geriatr Gerontol Int. 2015;15:26–33.
Jung HW, Kim KI. Blood pressure variability and cognitive function in the elderly. Pulse. 2013;1:29–34.
Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10–29.
Kamide K, Kabayama M. Implications of blood pressure variations in older populations. Hypertens Res. 2019;42:19–25.
Yeung SE, Loken Thornton W. "Do it-yourself": home blood pressure as a predictor of traditional and everyday cognition in older adults. PLoS ONE. 2017;12:e0177424.
Matsumoto A, Satoh M, Kikuya M, Ohkubo T, Hirano M, Inoue R, et al. Day-to-day variability in home blood pressure is associated with cognitive decline: the Ohasama study. Hypertension. 2014;63:1333–8.
Oishi E, Ohara T, Sakata S, Fukuhara M, Hata J, Yoshida D, et al. Day-to-day blood pressure variability and risk of dementia in a general Japanese elderly population: The Hisayama Study. Circulation. 2017;136:516–25.
Liu Z, Zhao Y, Zhang H, Chai Q, Cui Y, Diao Y, et al. Excessive variability in systolic blood pressure that is self-measured at home exacerbates the progression of brain white matter lesions and cognitive impairment in the oldest old. Hypertens Res. 2016;39:245–53.
Ryuno H, Kamide K, Gondo Y, Nakama C, Oguro R, Kabayama M, et al. Differences in the association between high blood pressure and cognitive functioning among the general Japanese population aged 70 and 80 years: The SONIC study. Hypertens Res. 2016;39:557–63.
Gondo Y, Masui Y, Kamide K, Ikebe K, Arai Y, Ishizaki T. SONIC Study: A longitudinal cohort study of the older people as part of a Centenarian study. In NA Pachana, editor. Encyclopedia of geropsychology. Singapore: Springer Science+Business Media; 2016.
Ikebe K, Gondo Y, Kamide K, Masui Y, Ishizaki T, Arai Y, et al. Occlusal force is correlated with cognitive function directly as well as indirectly via food intake in community-dwelling older Japanese: From the SONIC study. PLoS ONE. 2018;13:e0190741 https://doi.org/10.1371/journal.pone.0190741.
Godai K, Kabayama M, Saito K, Asayama K, Yamamoto K, Sugimoto K, et al. Validation of an automated home blood pressure measurement device in oldest-old populations. Hypertens Res. 2019. https://doi.org/10.1038/s41440-019-0330-7.
Fujiwara Y, Suzuki H, Yasunaga M, Sugiyama M, Ijuin M, Sakuma N, et al. Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int. 2010;10:225–32.
Ciesielska N, Sokołowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kędziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50:1039–52.
Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010;1:212–28.
Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84:167–76.
Conway KS, Forbang N, Beben T, Criqui MH, Ix JH, Rifkin DE. Relationship between 24-Hour ambulatory blood pressure and cognitive function in community-living older adults: the UCSD Ambulatory Blood Pressure Study. Am J Hypertens. 2015;28:1444–52.
Kalaria RN. Cerebrovascular disease and mechanisms of cognitive impairment: evidence from clinicopathological studies in humans. Stroke. 2012;43:2526–34.
Rickards CA, Tzeng YC. Arterial pressure and cerebral blood flow variability: friend or foe? a review. Front Physiol. 2014;5:120.
Johansson JK, Niiranen TJ, Puukka PJ, Jula AM. Factors affecting the variability of home-measured blood pressure and heart rate: the Finn-home study. J Hypertens. 2010;28:1836–45.
Zhang Y, Agnoletti D, Blacher J, Safar ME. Blood pressure variability in relation to autonomic nervous system dysregulation: the X-CELLENT study. Hypertens Res. 2012;35:399–403.
Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K. Visit-to-visit blood pressure variations: new independent determinants for cognitive function in the elderly at high risk of cardiovascular disease. J Hypertens. 2012;30:1556–63.
Sabayan B, Wijsman LW, Foster-Dingley JC, Stott DJ, Ford I, Buckley BM, et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: prospective cohort study. BMJ. 2013;347:f4600.
Duprez DA. Systolic hypertension in the elderly: addressing an unmet need. Am J Med. 2008;121:179–84.
Stewart R, Xue QL, Masaki K, Petrovitch H, Ross GW, White LR, et al. Change in blood pressure and incident dementia: a 32-year prospective study. Hypertension. 2009;54:233–40.
Power MC, Tchetgen EJ, Sparrow D, Schwartz J, Weisskopf MG. Blood pressure and cognition: factors that may account for their inconsistent association. Epidemiology. 2013;24:886–93.
Quan M, Xun P, Chen C, Wen J, Wang Y, Wang R, et al. Walking pace and the risk of cognitive decline and dementia in elderly populations: a meta-analysis of prospective cohort studies. J Gerontol A Biol Sci Med Sci. 2017;72:266–70.
Parati G, Ochoa JE, Lombardi C, Salvi P, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.
Peters R, Anstey KJ, Booth A, Beckett N, Warwick J, Antikainen R, et al. Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort. Eur Heart J. 2018;39:3135–43.
Zhao JH, Tian XJ, Liu YX, Yuan B, Zhai KH, Wang CW, et al. Executive dysfunction in patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion. Neurol Med Chir. 2013;53:141–7.
Saunders NL1, Summers MJ. Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment. Neuropsychology. 2011;25:237–48.
Narazaki K, Nofuji Y, Honda T, Matsuo E, Yonemoto K, Kumagai S. Normative data for the montreal cognitive assessment in a Japanese community-dwelling older population. Neuroepidemiology. 2013;40:23–29.
Acknowledgements
We are grateful to all SONIC participants who participated in these studies. We sincerely appreciate all staff involved in the SONIC study, especially Yumiko Aoshima, Tae Matsue, and Yasuyo Takamine, for their secretarial work and support.
SONIC Study Group
Kazuya Taira10, Werayuth Srithumsuk10, Nonglak Klinpudtan10, Naoko Wada10, Atsuko Higuchi10, Serina Yokoyama3, Satomi Maeda3, Motonori Nagasawa3, Taku Fujimoto3, Kennichi Matsuda11, Taiji Ogawa11, Masahiro Kitamura11, Yoshinobu Maeda11
Funding
This study was supported by a grant-in-aid from JSPS KAKENHI (KK: 15K08910, 19K07888, KA: 17H04126).
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Godai, K., Kabayama, M., Gondo, Y. et al. Day-to-day blood pressure variability is associated with lower cognitive performance among the Japanese community-dwelling oldest-old population: the SONIC study. Hypertens Res 43, 404–411 (2020). https://doi.org/10.1038/s41440-019-0377-5
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DOI: https://doi.org/10.1038/s41440-019-0377-5
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