January 13, 2015Open Access
View Full PaperSystolic Blood Pressure Variation and Mean Heart Rate Is Associated With Cognitive Dysfunction in Patients With High Cardiovascular Risk
Key Result
Higher visit-to-visit systolic blood pressure variation and mean heart rate independently predicted cognitive dysfunction in high cardiovascular risk patients (OR 1.32 and OR 1.40, respectively).
Study Design
Type
RCT (n=24,593)
Multicenter
Yes
Structured PICO
Do high systolic blood pressure visit-to-visit variation and high mean heart rate increase the risk of cognitive dysfunction in patients with high cardiovascular risk?
P
Population
24,593 patients without preexisting cognitive dysfunction at high cardiovascular risk (from the ONTARGET and TRANSCEND trials)
I
Intervention
High systolic blood pressure visit-to-visit variation (SBP-CV) and high mean heart rate
C
Comparator
Low systolic blood pressure visit-to-visit variation and low mean heart rate (1st quintile)
O
Outcome
Cognitive dysfunction (fall in mini mental state examination ≤24 points)
In patients at high cardiovascular risk, greater visit-to-visit systolic blood pressure variation and higher mean heart rate are independent predictors of cognitive decline and dysfunction.
Main Result
Effect estimate: OR 1.32 and OR 1.40 (95% CI 1.10-1.58 and 1.18-1.66)
p-value: p=0.0030 and 0.0008
Abstract
UNLABELLED: Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation standard deviation/mean×100%, CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios 95% confidence intervals, 1.32 1.10-1.58 for 5th versus 1st quintile of SBP-CV and 1.40 1.18-1.66 for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.