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

2. Overview
Observational study of older adults with cognitive impairment showed that high-normal levels of systolic blood pressure (SBP) of 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

3. 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

4. Tertiles of Patients By Clinic and Ambulatory Blood Pressure
Clinical
SBP
Daytime
Nighttime
Lower
≤125
mmHg
≤128
≤119
Average
mmHg
Higher
≥150
≥145
≥136
SBP, systolic blood pressure.

5. 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.

6. 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

7. 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

8. 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

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