Number of Home Blood Pressure Measurement and Cognitive Impairment

Objective: The advantage of home blood pressure (BP) measurement compared to office BP measurement can only be achieved if the patients remember to take the measurements as instructed. Cognitive function tends to decline with age, and individuals with mild cognitive impairment (MCI) often have difficulty completing established self-management tasks. Design and method: The aim of this study was to investigate the association between the number of days within a 5-and-a-half-day period that patients took their home BP as instructed and MCI assessed by the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in an elderly clinical population. Results: We analyzed 303 ambulatory patients (mean age 77.3±8.2 years) in whom MoCA-J had been assessed, who were instructed to take home BP for 1 evening and twice a day for the next five days, and who had at least one morning home BP measurement. The average total MoCA-J score was 18.5±6.0 points. After accounting for patient characteristics including age, sex, body mass index, drinking, smoking, prevalent cardiovascular disease, morning systolic BP and diastolic BP, and the use of antihypertensive drugs, the number of days home BP was measured was independently associated with both total MoCA-J score (estimate, 0.82; 95% confidence interval [CI], 0.43–1.21; P<0.001) and the lowest quartile of MoCA-J score (13 or below) (odds ratio [OR], 0.72; 95%CI, 0.59–0.87; P=0.001). Home BP measurement noncompliance (< 5 days’ measurement) was also independently associated with the total MoCA-J score (estimate, -2.56; 95%CI, -4.09 to -1.03; P=0.001) and the lowest quartile of MoCA-J score (OR, 3.32; 95%CI, 1.59–6.96; P=0.001). Conclusions: Poor compliance with home BP monitoring was associated with cognitive impairment in elderly cases who had been specifically instructed to perform home BP monitoring during a designated period.