Key result
Greater in-hospital BP variability is linked to ~5% higher risk of incident dementia post-discharge.
Why the study?
Blood pressure variability is a recognized potential risk factor for dementia, but whether blood pressure variability measured during acute care hospitalization is associated with incident dementia risk was unknown.
Does blood pressure variability during acute care hospitalization predict incident dementia in adults?
Cohort (n=81,892)
No
Does blood pressure variability during acute care hospitalization predict incident dementia in adults?
Effect estimate: HR 1.05 (95% CI 1.00-1.09)
Blood pressure variability measured during acute care hospitalizations is associated with an increased risk of developing incident dementia within approximately 5 years, suggesting its potential utility for risk stratification.
May support BP variability as a dementia risk marker in hospitalized adults; leaves open causal role and need for prospective validation.
Background and objectives: Recognized as a potential risk factor for Alzheimer's disease and related dementias (ADRD), blood pressure variability (BPV) could be leveraged to facilitate identification of at-risk individuals at a population level. Granular BPV data are available during acute care hospitalization periods for potentially high-risk patients, but the incident ADRD risk association with BPV measured in this setting is unknown. Our objective was to evaluate the relation of BPV, measured during acute care hospitalization, and incidence of ADRD. Methods: We retrospectively studied adults, without a prior ADRD diagnosis, who were admitted to a large quaternary care medical center in Southern California between January 1, 2013 and December 31, 2019. For all patients, determined BPV, calculated as variability independent of the mean (VIM), using blood pressure readings obtained as part of routine clinical care. We used multivariable Cox proportional hazards regression to examine the association between BP VIM during hospitalization and the development of incident dementia, determined by new ICD-9/10 coding or the new prescription of dementia medication, occurring at least 2 years after the index hospitalization. Results: Of 81,892 adults hospitalized without a prior ADRD diagnosis, 2,442 (2.98%) went on to develop ADRD (2.6 to 5.2 years after hospitalization). In multivariable-adjusted Cox models, both systolic (HR 1.05, 95% CI 1.00-1.09) and diastolic (1.06, 1.02-1.10) VIM were associated with incident ADRD. In pre-specified stratified analyses, the VIM associations with incident ADRD were most pronounced in individuals over age 60 years and among those with renal disease or hypertension. Results were similar when repeated to include incident ADRD diagnoses made at least 1 or 3 years after index hospitalization. Discussion: We found that measurements of BPV from acute care hospitalizations can be used to identify individuals at risk for developing a diagnosis of ADRD within approximately 5 years. Use of the readily accessible BPV measure may allow healthcare systems to risk stratify patients during periods of intense patient-provider interaction and, in turn, facilitate engagement in ADRD screening programs.
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Ebinger et al. (2023) conducted a cohort in Hospitalized adults without prior ADRD diagnosis (n=81,892). Blood pressure variability (BPV) measured as variability independent of the mean (VIM) vs. Lower blood pressure variability was evaluated on Incident dementia (ADRD) diagnosis at least 2 years after index hospitalization (HR 1.05, 95% CI 1.00-1.09). Greater systolic and diastolic blood pressure variability during acute care hospitalization were associated with an increased risk of incident dementia (HR 1.05 and 1.06, respectively) at least 2 years post-discharge.
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