Visit-to-visit blood pressure variations:  new independent determinants for cognitive function in the elderly at high risk of cardiovascular disease.
OBJECTIVE
Recently, visit-to-visit blood pressure (BP) variability has been shown to be associated with silent cerebral injury and stroke. However, the relationships between visit-to-visit BP variation and cognitive function are not clear.


METHODS
The cognitive function was evaluated using a mini-mental state examination (MMSE) and global deterioration scale (GDS) in 201 elderly patients at high risk of cardiovascular disease (CVD) (79.9 ± 6.4 years old; women 75%). Based on 12 visits (once a month), visit-to-visit BP variability (expressed as the SD and coefficient of variation), maximum BP, minimum BP, and δ (maximum - minimum) BP were measured.


RESULTS
The MMSE score had significant negative correlations with coefficient of variation and δ in SBP, and δDBP. The GDS score had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. Low MMSE score (<24) had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. High GDS score (>3) had significant positive correlations with coefficient of variation and δ in SBP, and δDBP. In a multiple linear regression analysis adjusted for confounders, coefficient of variation (P < 0.001) and δ (P < 0.001) in SBP had significant negative associations with the MMSE score. The δSBP (P < 0.05) had significant positive association with the GDS score. The coefficient of variation and δ in SBP had significant positive associations with low MMSE score (P < 0.01, P < 0.01, respectively) and high GDS score (P < 0.05, P < 0.001, respectively).


CONCLUSIONS
In the high-risk elderly, exaggerated visit-to-visit BP fluctuations were significant indicators for cognitive impairment.
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Japan.
Michiaki
M
Nagai
Satoshi
S
Hoshide
Joji
J
Ishikawa
Kazuyuki
K
Shimada
Kazuomi
K
Kario
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D009819:Office Visits; D015203:Reproducibility of Results