High visit-to-visit systolic blood pressure variability increased the risk of dementia compared to lower variability in both treated (HR 1.43) and untreated (HR 1.50) participants.
Cohort (n=301,448)
Does high visit-to-visit blood pressure variability increase the risk of dementia in adults aged >50 years?
High visit-to-visit blood pressure variability is associated with an increased risk of dementia, regardless of antihypertensive treatment status or medication adherence.
Effect estimate: HR 1.43 (95% CI 1.09-1.89)
Abstract This retrospective cohort study evaluated the association between visit-to-visit blood pressure (BP) variability and dementia risk, considering antihypertensive drug classes and medication adherence using Japanese National Health Insurance data (2015–2023) of 301,448 participants (age: 66.6 years, male: 38.6%). Visit-to-visit systolic BP (SBP) variability was assessed using the coefficient of variation (CV) from five annual health check-ups. The outcome was antidementia drug initiation as a proxy for dementia diagnosis and was analyzed using Fine-Gray models, with death as the competing outcome. For participants untreated/treated with antihypertensive medication, 366/298 initiated antidementia drugs during 2.20 ± 1.19/2.11 ± 1.19 years of follow-up, respectively. The highest SBP-CV sextile was associated with dementia risk regardless of treatment status: hazard ratio of the 6 th sextile (SBP-CV ≥ 9.83%) vs. 1 st –5 th sextiles was 1.50 (95% confidence interval CI: 1.17–1.92) for untreated participants, while for treated participants, the hazard ratio of the 6 th sextile (SBP-CV ≥ 10.67%) was 1.43 (95%CI: 1.09–1.89) after further adjusting for antihypertensive drug classes and medication adherence assessed by medication possession rate. In the stratification analyses by baseline characteristics, only HbA1c in treated participants demonstrated a significant interaction with SBP-CV for dementia risk; this association was pronounced among treated participants with HbA1c ≥ 6.5% (interaction P = 0.024). No significant interactions were observed among antihypertensive drugs, poor adherence, and SBP-CV in relation to dementia risk. High visit-to-visit BP variability, indicated by a CV of approximately ≥10%, is associated with dementia, regardless of treatment status. In the treated participants, this association persisted even after accounting for antihypertensive drug classes and medication adherence.
Satoh et al. (2025) conducted a cohort in Dementia (n=301,448). High visit-to-visit systolic blood pressure variability (highest sextile) vs. Lower visit-to-visit systolic blood pressure variability (1st-5th sextiles) was evaluated on Antidementia drug initiation (proxy for dementia diagnosis) (HR 1.43, 95% CI 1.09-1.89). High visit-to-visit systolic blood pressure variability increased the risk of dementia compared to lower variability in both treated (HR 1.43) and untreated (HR 1.50) participants.