Key result
High visit-to-visit SBP variability linked to ~43% greater dementia risk regardless of treatment.
Why the study?
The study evaluated the association between visit-to-visit blood pressure variability and dementia risk, considering antihypertensive drug classes and medication adherence.
Does high visit-to-visit blood pressure variability increase the risk of dementia in adults aged >50 years?
Cohort (n=301,448)
Does high visit-to-visit blood pressure variability increase the risk of dementia in adults aged >50 years?
High visit-to-visit blood pressure variability is associated with an increased risk of dementia, regardless of antihypertensive treatment status or medication adherence.
Answers are grounded in this paper and cite their sources.
Supports BP variability monitoring in adults >50; extends observational data but leaves open causal effects and need for RCTs.
This retrospective cohort study evaluated the association between visit-to-visit blood pressure (BP) variability and dementia risk, considering antihypertensive drug classes and medication adherence using Japanese National Health Insurance data (2015–2023) of 301,448 participants (age: 66.6 years, male: 38.6%). Visit-to-visit systolic BP (SBP) variability was assessed using the coefficient of variation (CV) from five annual health check-ups. The outcome was antidementia drug initiation as a proxy for dementia diagnosis and was analyzed using Fine-Gray models, with death as the competing outcome. For participants untreated/treated with antihypertensive medication, 366/298 initiated antidementia drugs during 2.20 ± 1.19/2.11 ± 1.19 years of follow-up, respectively. The highest SBP-CV sextile was associated with dementia risk regardless of treatment status: hazard ratio of the 6 th sextile (SBP-CV ≥ 9.83%) vs. 1 st –5 th sextiles was 1.50 (95% confidence interval [CI]: 1.17–1.92) for untreated participants, while for treated participants, the hazard ratio of the 6 th sextile (SBP-CV ≥ 10.67%) was 1.43 (95%CI: 1.09–1.89) after further adjusting for antihypertensive drug classes and medication adherence assessed by medication possession rate. In the stratification analyses by baseline characteristics, only HbA1c in treated participants demonstrated a significant interaction with SBP-CV for dementia risk; this association was pronounced among treated participants with HbA1c ≥ 6.5% (interaction P = 0.024). No significant interactions were observed among antihypertensive drugs, poor adherence, and SBP-CV in relation to dementia risk. High visit-to-visit BP variability, indicated by a CV of approximately ≥10%, is associated with dementia, regardless of treatment status. In the treated participants, this association persisted even after accounting for antihypertensive drug classes and medication adherence.
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Satoh et al. (2025) conducted a cohort in Dementia (n=301,448). High visit-to-visit systolic blood pressure variability (highest sextile) vs. Lower visit-to-visit systolic blood pressure variability (1st-5th sextiles) was evaluated on Antidementia drug initiation (proxy for dementia diagnosis) (HR 1.43, 95% CI 1.09-1.89). High visit-to-visit systolic blood pressure variability increased the risk of dementia compared to lower variability in both treated and untreated participants.
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