title: Both Low and High 24-Hour Diastolic Blood Pressure Are Associated With Worse Cognitive Performance in Type 2 Diabetes: The Maastricht Study.
abstract: OBJECTIVE
  Hypertension and diabetes are both risk factors for cognitive decline, and individuals with both might have an especially high risk. We therefore examined linear and nonlinear (quadratic) associations of 24-h blood pressure (BP) with cognitive performance in participants with and without type 2 diabetes. We also tested the association of nocturnal dipping status with cognitive performance.
  
  
  METHODS
  This study was performed as part of the Maastricht Study, an ongoing population-based cohort study. Cross-sectional associations of 24-h BP (n = 713, of whom 201 had type 2 diabetes) and nocturnal dipping status (n = 686, of whom 196 had type 2 diabetes) with performance on tests for global cognitive functioning, information processing speed, verbal memory (immediate and delayed word recall), and response inhibition were tested using linear regression analysis and adjusted for demographics, vascular risk factors, cardiovascular disease, depression, and lipid-modifying and antihypertensive medication use.
  
  
  RESULTS
  After full adjustment, we found quadratic (inverted U-shaped) associations of 24-h diastolic blood pressure (DBP) with information processing speed (b for quadratic term = -0.0267, P < 0.01) and memory (immediate word recall: b = -0.0180, P < 0.05; delayed word recall: b = -0.0076, P < 0.01) in participants with diabetes, but not in those without. No clear pattern was found for dipping status.
  
  
  CONCLUSIONS
  This study shows that both low and high 24-h DBP are associated with poorer performance on tests of information processing speed and memory in individuals with type 2 diabetes.
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
authors.forename: Peggy J J
authors.initials: PJ
authors.lastname: Spauwen
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands martin.vanboxtel@maastrichtuniversity.nl.
authors.forename: Martin P J
authors.initials: MP
authors.lastname: van Boxtel
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Simone J S
authors.initials: SJ
authors.lastname: Sep
authors.affiliation: Department of Social Medicine, Maastricht University, Maastricht, the Netherlands School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Ronald M A
authors.initials: RM
authors.lastname: Henry
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Carla J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000523:psychology; D003971:Diastole; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009426:Netherlands
chemical_list: D000959:Antihypertensive Agents