Higher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard BP lowering group (HR 2.56; 95% CI 1.16-5.62; p=0.019).
RCT (n=793)
open-label
randomized
Yes
Does intensive blood pressure lowering modify the association between ambulatory blood pressure variability and probable dementia in patients at increased risk for cardiovascular disease?
Higher 24-hour systolic blood pressure variability is associated with an increased risk of probable dementia in patients receiving standard blood pressure control, but this risk appears to be mitigated by intensive blood pressure lowering.
Effect estimate: HR 2.56 (95% CI 1.16-5.62)
p-value: p=0.019
BACKGROUND: Blood pressure variability is an emerging risk factor for dementia, independent and oftentimes beyond mean blood pressure levels. Recent evidence from interventional cohorts with rigorously controlled mean blood pressure levels suggest blood pressure variability over months to years remains a risk for dementia, but no prior studies have investigated relationships with blood pressure variability over shorter time periods. OBJECTIVES: To investigate the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering. DESIGN: Post hoc analysis of the randomized, controlled, open-label Systolic Blood Pressure Intervention Trial clinical trial. SETTING: Multisite Systolic Blood Pressure Intervention Trial. PARTICIPANTS: 793 participants at increased risk for cardiovascular disease and without history of dementia at study randomization. INTERVENTION: Standard (<140 mmHg systolic blood pressure target) vs intensive (<120 mmHg systolic blood pressure target) lowering of mean blood pressure. MEASUREMENTS: 24-hour ambulatory blood pressure monitoring 27 months after treatment randomization (standard vs intensive) and follow-up cognitive testing. Intraindividual blood pressure variability was calculated as the average real variability over 24-hour, daytime, and nighttime periods. Participants were categorized into 3 adjudicated clinical outcomes: no cognitive impairment, mild cognitive impairment, probable dementia. Cox proportional hazards models examined the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering. Associations with mean blood pressure were also explored. RESULTS: Higher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard group (adjusted hazard ratio HR: 2.56 95% CI 1.16, 5.62, p = 0.019) but not in the intensive group (HR: 0.54 95% CI 0.24, 1.23, p = 0.141). Similar findings were observed with daytime systolic blood pressure variability but not nighttime blood pressure variability. Mean blood pressure was not associated with cognitive outcomes. CONCLUSIONS: Higher systolic 24-hour and daytime blood pressure variability via ambulatory monitoring is associated with risk for dementia under standard blood pressure treatment. Findings support prior evidence that blood pressure variability remains a risk for dementia despite strict control of mean blood pressure levels.
Sible et al. (Thu,) conducted a rct in increased risk for cardiovascular disease (n=793). Intensive blood pressure lowering (<120 mmHg systolic target) vs. Standard blood pressure lowering (<140 mmHg systolic target) was evaluated on probable dementia (HR 2.56, 95% CI 1.16-5.62, p=0.019). Higher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard BP lowering group (HR 2.56; 95% CI 1.16-5.62; p=0.019).