title: Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline.
abstract: The association between visit-to-visit variability of blood pressure (BP) and cognitive decline over time remains incompletely understood in a general population of older adults. We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. This prospective cohort study comprised 976 adults who had 3 or 4 visits with BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed cognitive screening tests at ≥2 visits in 1997, 2000, or 2004. Visit-to-visit BP variability was expressed as the SD, coefficient of variation, or as the variation independent of mean BP across visits conducted at a mean interval of 3.2 years. Mean (SD) age at the first cognitive test was 64 (6) years. Using multivariable-adjusted linear mixed-effects models, we found higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% confidence interval] for high versus low tertile of SD variability: standardized composite scores -0.038 standard units (SU)/y [-0.066 to -0.009] and verbal memory -0.041 SU/y [-0.075 to -0.008]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of cognitive function, independent of mean diastolic BP, among adults aged 55 to 64 years but not those ≥65 years. Our results suggest that higher long-term BP visit-to-visit variability is associated with a faster rate of cognitive decline among older adults.
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Bo
authors.initials: B
authors.lastname: Qin
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Plassman
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: Edwards
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Linda S
authors.initials: LS
authors.lastname: Adair
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
authors.affiliation: From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.). mmendez@email.unc.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mendez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002681:China; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D057187:Independent Living; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: aging; blood pressure; cognition; hypertension; longitudinal studies