From ESH 2016 | POS 3C: Chiara Lorenzi, MD

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Optimal Blood Pressure Level to Prevent Cognitive Decline in Older Adults From ESH 2016 | POS 3C: Chiara Lorenzi, MD AOU, University of Florence, Italy

Overview Observational study of older adults with cognitive impairment showed that high-normal levels of systolic blood pressure (SBP) of 130-145 mmHg may be the optimal target to reduce the progression of cognitive decline and reduce the risk of mortality at 3 years Relation between blood pressure and cognitive impairment complex Scarce and contradictory data on prognostic role of high blood pressure in this population Many studies demonstrated high blood pressure can increase dementia

Study Design 198 patients included 135 patients had dementia at baseline, 68.9% had cognitive follow-up at baseline and 3 years Evaluated 3-year association between clinic blood pressure (CBP), ambulatory blood pressure monitoring (ABPM), and antihypertensive medications Patients divided into tertiles based on CBP and ABPM

Tertiles of Patients By Clinic and Ambulatory Blood Pressure Clinical SBP Daytime Nighttime Lower ≤125 mmHg ≤128 ≤119 Average 126-149 129-144 mmHg 120-135 Higher ≥150 ≥145 ≥136 SBP, systolic blood pressure.

Baseline Characteristics in Study of Cognitive Decline Total sample Cognitive follow-up Telephone follow-up Sample N=198 N=135 N=63 Age 79 ± 5 Female, n (%) 126 (63,6%) 92 (68,1%) 34 (54,0%) Dementia 121 (61,1%) 93 (68,9%) 28 (44,4%) High blood pressure 142 (71,7%) 98 (72,6%) 44 (69,8%) Vascular comorbosity index 1,5 ± 1,2 1,5 ± 1,3 1,5 ± 1,1 Antihypertensive drugs 136 (68,7%) 95 (70,4%) 41 (65,1%) Clinic SBP 139,3 ± 20,9 137,4 ± 19,9 143,3 ± 22,5 Clinic DBP 76,3 ± 10,3 76,1 ± 10,5 76,6 ± 10,0 Mean daytime SBP 136,9 ± 15,6 135,6 ± 15,0 139,6± 16,6 Mean night-time SBP 129,1 ± 18,4 (n=185) 126,2 ± 17,1 (n=124) 135,1 ± 19,7 (n=61) MMSE 22,4 ± 4,4 21,8 ± 4,6 23,6 ± 3,8 Lost BADL 0,9 ± 1,2 0,9 ± 1,4 Lost IADL 2,7 ± 2,4 3,0 ± 2,5 2,4 ± 2,2 BADL, basic activities of daily living; DBP, diastolic blood pressure; IADL, instrumental activities of daily living; MMSE, Mini Mental State Examination; SBP, systolic blood pressure.

Results No association between clinic SBP and event rate across tertiles Higher rate of morality with higher mean nighttime SBP in treated (p=0.005) and untreated patients (p=0.008) Independent association, after adjustment for age, sex, functional status, and cognitive status Higher rate of mortality with higher mean daytime SBP, but not significant

Results No association between cognitive outcomes and CBP Greater progression in cognitive decline with lower mean SBP (p=0.029) Similar trend for lower mean nighttime SBP, but not significant Independent association between lower daytime SBP and progression of cognitive decline (p=0.026), after adjustment

Results Association between treatment and greater progression in cognitive decline with lower mean daytime SBP (p=0.002) and lower mean nighttime SBP (p=0.033), compared with those patients not treated

Optimal Blood Pressure Level to Prevent Cognitive Decline in Older Adults From ESH 2016 | POS 3C: Chiara Lorenzi, MD AOU, University of Florence, Italy