Key result
Treated SBP >150 mm Hg linked to ~1 point less MMSE decline vs <130 mm Hg.
Why the study?
Hypertension trials often exclude patients with complex health problems and lack generalizability, leaving uncertainty about the association between systolic blood pressure and cognitive or functional changes in this population.
Does higher systolic blood pressure (≥130 mm Hg) prevent cognitive decline in older adults aged ≥75 years on antihypertensive therapy?
Cohort (n=1,266)
Yes
Does higher systolic blood pressure (≥130 mm Hg) prevent cognitive decline in older adults aged ≥75 years on antihypertensive therapy?
Mean Difference: 1.01 (95% CI 0.47–1.55)
p-value: p=<0.001
In older adults aged ≥75 years on antihypertensive therapy, higher systolic blood pressure (≥130 mm Hg) is associated with less cognitive decline over 1 year, particularly in those with complex health problems.
Should not yet alter BP targets in adults ≥75 years; hypothesis-generating observational association needing randomized confirmation.
PURPOSE Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems. METHODS We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty. RESULTS Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP <130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP >150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend <.001), not in those without (P for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment. CONCLUSIONS Participants aged ≥75 years undergoing antihypertensive treatment, with SBP ≥130 mm Hg compared to <130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.
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Streit et al. (2019) conducted a cohort in Hypertension (n=1,266). Systolic blood pressure >150 mm Hg vs. Systolic blood pressure <130 mm Hg was evaluated on 1-year change in cognitive function (MMSE score) (MD 1.01, 95% CI 0.47-1.55, p=<0.001). In older adults ≥75 years on antihypertensive treatment, systolic blood pressure >150 mm Hg was associated with 1.01 points less cognitive decline on the MMSE over 1 year compared to <130 mm Hg.
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