Key result
Higher BP links to better cognition in the oldest-old only when waist circumference is low.
Why the study?
Prior studies suggest a changing association between blood pressure and cognition with aging, but results in the oldest-old have been ambiguous and may be influenced by modifying factors.
Does blood pressure associate with cognitive composite score in the oldest-old, and is it modified by physical, vascular, or brain pathology markers?
Cross-Sectional (n=122)
Does blood pressure associate with cognitive composite score in the oldest-old, and is it modified by physical, vascular, or brain pathology markers?
In the oldest-old, the association between blood pressure and cognition is modified by waist circumference, suggesting physical vulnerability may influence the cognitive effects of blood pressure.
Should not yet guide BP targets by waist circumference in oldest-old; leaves open whether body habitus modifies cognitive outcomes in prospective studies.
BACKGROUND: Prior studies suggest a changing association between blood pressure (BP) and cognition with aging, however work in the oldest-old has yielded ambiguous results. Potentially, these mixed results can be explained by modifying factors. The aim of this study was to establish whether physical, vascular or brain pathology markers that describe a state of increased vulnerability, affect the association between BP and cognition in the oldest-old. Results may influence clinicians' decisions regarding the use of antihypertensives in this age group. METHODS: We included 122 individuals (84 without cognitive impairment and 38 with cognitive impairment) from the EMIF-AD 90 + Study (mean age 92.4 years). First, we tested cross-sectional associations of systolic and diastolic BP with a cognitive composite score. Second, we tested whether these associations were modified by physical markers (waist circumference, muscle mass, gait speed and handgrip strength), vascular markers (history of cardiac disease, carotid intima media thickness as a proxy for atherosclerosis and carotid distensibility coefficient as a proxy for arterial stiffness) or brain pathology markers (white matter hyperintensities and cortical thickness). RESULTS: In the total sample, there was no association between BP and cognition, however, waist circumference modified this association (p-value for interaction with systolic BP: 0.03, with diastolic BP: 0.01). In individuals with a high waist circumference, higher systolic and diastolic BP tended to be associated with worse cognition, while in individuals with a low waist circumference, higher systolic BP was associated with better cognition. The others physical, vascular and brain pathology markers did not modify the association between BP and cognition. CONCLUSIONS: When examining various markers for physical, vascular and brain vulnerability, only waist circumference affected the association between BP and cognition. This warrants further research to evaluate whether waist circumference may be a marker in clinical practice influencing the use of antihypertensives in the oldest-old.
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Legdeur et al. (2023) conducted a cross-sectional in Cognitive impairment in the oldest-old (n=122). Blood pressure (systolic and diastolic) was evaluated on Cognitive composite score (z-score) (β 0.03, 95% CI -0.09 to 0.16). Waist circumference significantly modified the association between blood pressure and cognition in the oldest-old (p=0.03 for interaction with systolic BP), such that higher blood pressure was associated with better cognition only in individuals with a low waist circumference.
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