title: Excessive variability in systolic blood pressure that is self-measured at home exacerbates the progression of brain white matter lesions and cognitive impairment in the oldest old.
abstract: To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined -4.76 (interquartile ranges: -10.71, -0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P<0.05). The significant differences were retained after adjusting for covariates, including the MMSE score, periventricular WMH, deep WMH and WMH fraction at the baseline (P<0.05). Excessive variability in self-measured systolic HBP exacerbates the progression of cognitive impairment and brain white matter lesions in the oldest old.
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Yingxin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chai
authors.affiliation: Department of Radiology, Qilu Hospital of Shandong University, Shandong, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Yutao
authors.initials: Y
authors.lastname: Diao
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Jianchao
authors.initials: J
authors.lastname: Xiu
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, China.
authors.forename: Guosheng
authors.initials: G
authors.lastname: Jiang
mesh_terms: D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology