Key result
In very old individuals with severe cognitive impairment (MMSE 0-10), systolic blood pressure ≥165 mmHg significantly increased 2-year all-cause mortality compared to 126-139 mmHg (HR 4.54).
Why the study?
Does the association of systolic blood pressure with mortality differ with respect to cognitive function in very old individuals?
Cohort (n=1,115)
Yes
Does the association of systolic blood pressure with mortality differ with respect to cognitive function in very old individuals?
In very old individuals with severe cognitive impairment, both low (≤125 mmHg) and high (≥165 mmHg) systolic blood pressure are associated with increased 2-year mortality.
Answers are grounded in this paper and cite their sources.
High SBP may raise mortality in severe cognitive impairment; hypothesis-generating and should not yet alter practice.
OBJECTIVE: Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia.This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals. METHODS: The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umeå85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death. RESULTS: Mean age, MMSE score, and SBP and DBP were 89.4 ± 4.6 years, 21.1 ± 7.6, 146.1 ± 23.4 mmHg, and 74.1 ± 11.7 mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0-10 among whom mortality risk was increased in association with SBP at least 165 mmHg and 125 mmHg or less, compared with 126-139 mmHg (adjusted hazard ratio 4.54, 95% confidence interval = 1.52-13.60 and hazard ratio 2.23, 95% confidence interval = 1.12-4.45, respectively). In age and sex-adjusted analyses, SBP 125 mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18. CONCLUSION: In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.
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Weidung et al. (2016) conducted a cohort in Cognitive impairment and hypertension (n=1,115). Systolic blood pressure ≥165 mmHg vs. Systolic blood pressure 126-139 mmHg was evaluated on All-cause mortality within 2 years (HR 4.54, 95% CI 1.52-13.60, p=0.007). In very old individuals with severe cognitive impairment (MMSE 0-10), systolic blood pressure ≥165 mmHg significantly increased 2-year all-cause mortality compared to 126-139 mmHg (HR 4.54).
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