title: Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study.
abstract: BACKGROUND
  Previous studies have reported a higher prevalence of dementia in persons with low blood pressure.
  
  
  OBJECTIVE
  To examine whether low blood pressure is prospectively associated with the occurrence of Alzheimer disease and dementia in elderly people.
  
  
  METHODS
  A community-based, dementia-free cohort (n = 1270) aged 75 to 101 years was longitudinally examined twice within 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria. Cox proportional hazards models were used to analyze blood pressure in association with dementia after adjustment for several potential confounders.
  
  
  RESULTS
  During the 6-year period, 339 subjects were diagnosed with dementia, including 256 persons with Alzheimer disease. Subjects with very high systolic pressure (>180 vs 141-180 mm Hg) had an adjusted relative risk of 1.5 (95% confidence interval [CI], 1.0-2.3; P =.07) for Alzheimer disease, and 1.6 (95% CI, 1.1-2.2) for dementia. Low systolic pressure (</=140 mm Hg) was not related to incident dementia. In contrast, high diastolic pressure (>90 mm Hg) was not associated with dementia incidence, whereas extremely low diastolic pressure (</=65 vs 66-90 mm Hg) produced an adjusted relative risk of 1.7 (95% CI, 1.1-2.4) for Alzheimer disease and 1.5 (95% CI, 1.0-2.1; P =.03) for dementia. The latter association was pronounced particularly in persons who used antihypertensive drugs.
  
  
  CONCLUSIONS
  Both low diastolic and high systolic pressure are associated with an increased risk of Alzheimer disease and dementia in this elderly population. The atherosclerotic process may explain the observed associations. In addition, low diastolic pressure may increase dementia risk by affecting cerebral perfusion.
authors.affiliation: Aging Research Center, Department of NEUROTEC, Karolinska Institutet, Stockholm, Sweden. chengxuan.qiu@neurotec.ki.se
authors.forename: Chengxuan
authors.initials: C
authors.lastname: Qiu
authors.forename: Eva
authors.initials: E
authors.lastname: von Strauss
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
authors.forename: Bengt
authors.initials: B
authors.lastname: Winblad
authors.forename: Laura
authors.initials: L
authors.lastname: Fratiglioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000209:etiology* / Q000503:physiopathology; D001161:Arteriosclerosis / Q000503:physiopathology; D003704:Dementia / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000150:complications*; D008297:Male; D012307:Risk Factors