title: Association of higher diastolic blood pressure levels with cognitive impairment.
abstract: BACKGROUND
  We evaluated the cross-sectional relationship of blood pressure (BP) components with cognitive impairment after adjusting for potential confounders.
  
  
  METHODS
  Reasons for Geographic and Racial Differences in Stroke (REGARDS) is a national, longitudinal population cohort evaluating stroke risk in 30,228 black and white men and women >or=45 years old. During the in-home visit, BP measurements were taken as the average of 2 measurements using a standard aneroid sphygmomanometer. Excluding participants with prior stroke or TIA, the present analysis included 19,836 participants (enrolled from December 2003 to March 2007) with complete baseline physical and cognitive evaluations. Incremental logistic models examined baseline relationships between BP components (systolic blood pressure [SBP], diastolic blood pressure [DBP], and pulse pressure [PP]) and impaired cognitive status (score of <or=4 on 6-Item Screener) after adjusting for demographic and environmental characteristics, cardiovascular risk factors, depressive symptoms, and current use of any antihypertensive medication.
  
  
  RESULTS
  Higher DBP levels were associated with impaired cognitive status after adjusting for demographic and environmental characteristics, risk factors, depressive symptoms, and antihypertensive medications. An increment of 10 mm Hg in DBP was associated with a 7% (95% confidence interval [CI] 1%-14%, p = 0.0275) higher odds of cognitive impairment. No independent association was identified between impaired cognitive status and SBP (odds ratio [OR] 1.02, 95% CI 0.99-1.06) or PP (OR 0.99, 95% CI 0.95-1.04). There was no evidence of nonlinear relationships between any of the BP components and impaired cognitive status. There was no interaction between age and the relationship of impaired cognitive status with SBP (p = 0.827), DBP (p = 0.133), or PP (p = 0.827) levels.
  
  
  CONCLUSIONS
  Higher diastolic blood pressure was cross-sectionally and independently associated with impaired cognitive status in this large, geographically dispersed, race- and sex-balanced sample of stroke-free individuals.
authors.affiliation: Comprehensive Stroke Center, University of Alabama at Birmingham, RWUH M226, 1530 3rd Avenue S, Birmingham, AL 35294-3280, USA. tsivgoulisgiorg@yahoo.gr
authors.forename: G
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: A V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: V G
authors.initials: VG
authors.lastname: Wadley
authors.forename: F W
authors.initials: FW
authors.lastname: Unverzagt
authors.forename: R C P
authors.initials: RC
authors.lastname: Go
authors.forename: C S
authors.initials: CS
authors.lastname: Moy
authors.forename: B
authors.initials: B
authors.lastname: Kissela
authors.forename: G
authors.initials: G
authors.lastname: Howard
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
references.citation: Ann Neurol. 1999 Dec;46(6):827-33
references.pmid: 10589534
references.citation: Am J Hypertens. 2009 May;22(5):525-30
references.pmid: 19265790
references.citation: Lancet Neurol. 2005 Aug;4(8):487-99
references.pmid: 16033691
references.citation: Brain. 1988 Dec;111 ( Pt 6):1425-39
references.pmid: 3208064
references.citation: JAMA. 1995 Dec 20;274(23):1846-51
references.pmid: 7500533
references.citation: J Hypertens. 1997 Oct;15(10):1069-76
references.pmid: 9350580
references.citation: JAMA. 1999 Feb 3;281(5):438-45
references.pmid: 9952204
references.citation: Stroke. 2003 Mar;34(3):594-9
references.pmid: 12624277
references.citation: Am J Epidemiol. 1993 Sep 15;138(6):353-64
references.pmid: 8213741
references.citation: Cerebrovasc Dis. 2002;13 Suppl 2:16-20
references.pmid: 11901238
references.citation: Stroke. 2006 Jan;37(1):33-7
references.pmid: 16339468
references.citation: Int J Obes Relat Metab Disord. 2003 Feb;27(2):260-8
references.pmid: 12587008
references.citation: Hypertension. 1998 Mar;31(3):780-6
references.pmid: 9495261
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Neurology. 2001 Jun 26;56(12):1683-9
references.pmid: 11425934
references.citation: Arch Neurol. 2003 Aug;60(8):1123-8
references.pmid: 12925370
references.citation: Am J Epidemiol. 2006 Feb 1;163(3):197-203
references.pmid: 16339049
references.citation: Am J Epidemiol. 1991 Dec 1;134(11):1303-15
references.pmid: 1755444
references.citation: Lancet. 2005 Jan 15-21;365(9455):217-23
references.pmid: 15652604
references.citation: Drugs Aging. 1999 Nov;15(5):365-75
references.pmid: 10600044
references.citation: Am J Epidemiol. 1997 Jun 15;145(12):1106-13
references.pmid: 9199540
references.citation: Arch Neurol. 2005 Oct;62(10):1545-8
references.pmid: 16216937
references.citation: J Am Geriatr Soc. 2008 Aug;56(8):1449-58
references.pmid: 18637980
references.citation: Hypertension. 2005 Mar;45(3):374-9
references.pmid: 15699446
references.citation: J Neurol Neurosurg Psychiatry. 2005 Sep;76(9):1286-8
references.pmid: 16107369
references.citation: Neurology. 2004 Jun 8;62(11):2021-4
references.pmid: 15184608
references.citation: Gerontology. 1998;44(2):95-105
references.pmid: 9523221
references.citation: Neurology. 2005 Jan 25;64(2):263-7
references.pmid: 15668423
references.citation: J Hypertens. 1997 Feb;15(2):135-42
references.pmid: 9469788
references.citation: Circ Res. 1990 Jun;66(6):1747-54
references.pmid: 2344672
references.citation: Neuroepidemiology. 2005;25(3):135-43
references.pmid: 15990444
references.citation: J Am Geriatr Soc. 2002 Dec;50(12):2014-8
references.pmid: 12473014
references.citation: Hypertension. 2000 Dec;36(6):1079-82
references.pmid: 11116128
references.citation: Med Care. 2002 Sep;40(9):771-81
references.pmid: 12218768
references.citation: Neuroepidemiology. 2002 May-Jun;21(3):123-30
references.pmid: 12006775
references.citation: Am J Epidemiol. 1987 Dec;126(6):1103-14
references.pmid: 3687920
references.citation: J Gerontol A Biol Sci Med Sci. 2004 Nov;59(11):1191-4
references.pmid: 15602074
references.citation: Neurology. 2008 Sep 30;71(14):1057-64
references.pmid: 18367704