Blood pressure variability: A predictor of dementia and heart disease
Fluctuating blood pressure: a warning sign of dementia and heart disease? Learn the signs and symptoms so you can take action early.
DR T S DIDWAL MD
3/3/20245 min read
In recent years, there has been growing interest in the role of blood pressure variability (BPV) in cognitive functioning, particularly in older adults. High BPV, especially in the mid-term, has been identified as a potential independent risk factor for incident dementia. Understanding the intricate relationship between BPV and cognitive health is crucial for addressing cognitive impairment issues in the aging population. In this comprehensive article, we delve into a recent study that investigates the association between different measures of BPV and cognitive functioning, as well as vascular stiffness in older adults. This study, in Cerebral Circulation: Cognition and Behavior, investigated the connection between blood pressure variability (BPV) and cognitive function in older adults (60–80 years old) without dementia. It also examined the link between BPV and vascular stiffness.
The key findings were:
High BPV, both short-term and mid-term, was linked to poorer cognitive function, independent of average blood pressure.
Short-term BPV refers to fluctuations within a day (e.g., sleep vs. wake) and is associated with impaired attention and psychomotor speed.
Mid-term BPV refers to fluctuations over several days and is associated with lower executive function.
Circadian blood pressure patterns (day/night variations) did not significantly affect cognition.
High short-term systolic BPV was associated with increased arterial stiffness, suggesting damage to blood vessels.
High day-to-day diastolic BPV was linked with lower arterial stiffness, but the explanation remains unclear.
These findings suggest that BPV, particularly short-term and mid-term systolic BPV, may be a more crucial factor for cognitive function and vascular health than average blood pressure or even circadian rhythms.
This research suggests that BPV, especially in its short-term and mid-term forms, could be an important indicator of potential cognitive decline in older adults. Additionally, the link between BPV and arterial stiffness highlights the potential for BPV to contribute to vascular damage, which may further impact cognitive health.
Blood Pressure Variability: A Closer Look
Blood pressure is a fundamental parameter of our circulatory system, representing the force of blood against the walls of our arteries. While it's commonly measured as systolic (the pressure when the heart beats) and diastolic (the pressure when the heart is at rest) readings, blood pressure is not a constant value; it fluctuates throughout the day.
Factors Influencing Blood Pressure Variability
Various factors contribute to the fluctuations in blood pressure, including:
Circadian Rhythm: Our body's internal clock affects blood pressure, typically peaking in the morning and dipping at night.
Stress and Emotions: Emotional stress can cause a spike in blood pressure, leading to short-term variability.
Diet and Lifestyle: High salt intake, obesity, and excessive alcohol consumption can contribute to long-term blood pressure fluctuations.
Cognitive Effects of Blood Pressure Variability
Cognitive Decline: Research suggests that individuals with higher blood pressure variability are at a greater risk of cognitive decline and disorders like Alzheimer's disease.
Impaired Memory: Fluctuations in blood pressure may affect memory and cognitive performance.
Vascular Implications
Endothelial Dysfunction: Inconsistent blood flow can damage the delicate lining of blood vessels, increasing the risk of atherosclerosis.
Hypertension: Long-term variability can contribute to chronic hypertension, a major risk factor for heart disease and stroke.
Managing Blood Pressure Variability
Lifestyle Changes: A balanced diet, regular exercise, and stress management techniques can help stabilize blood pressure.
Medication: In some cases, antihypertensive medications may be prescribed to control blood pressure variability.
Investigating the Cognitive Impact
The study in question involved 70 older adults, aged between 60 and 80, who did not have dementia. These individuals underwent a battery of cognitive tests to assess their cognitive functioning. Simultaneously, their blood pressure was closely monitored. The study used two different approaches to measure BPV: short-term BPV, which was divided into sleep and wake cycles and assessed through a 24-hour ambulatory BP monitor, and mid-term BPV, which was evaluated using a 4-day morning and evening home-based BP monitor. The cognitive tests aimed to measure various aspects of cognitive function, including attention, psychomotor speed, and executive functioning.
The Relationship Between BPV and Cognitive Function
The findings of this study were particularly illuminating. They revealed that high systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, irrespective of the mean blood pressure levels. This suggests that fluctuations in blood pressure, rather than the baseline levels, may play a significant role in cognitive health.
Intriguingly, higher short-term BPV was specifically linked to poorer attention and psychomotor speed. This implies that fluctuations in blood pressure over short periods, such as within a day, may have a more pronounced effect on certain cognitive functions. On the other hand, day-to-day BPV was negatively associated with executive functioning, indicating that variability over a longer time span may impact higher-order cognitive processes.
Unraveling the Role of Circadian Patterns
The study also investigated circadian patterns of blood pressure, including dipping and morning BP surges. Surprisingly, these patterns did not exhibit significant relationships with cognitive function after adjusting for covariates. This suggests that while short- and mid-term BPV are crucial determinants of cognitive health, circadian patterns may not be as influential.
Implications for Vascular Health
Additionally, the study delved into the association between BPV and vascular stiffness. Higher systolic short-term BPV was positively associated with arterial stiffness, as measured by pulse wave velocity (PWV). Conversely, higher diastolic day-to-day BPV was linked with lower arterial stiffness. These findings highlight the impact of BPV on vascular health in older adults. It suggests that fluctuations in blood pressure may not only affect cognitive function but also have implications for the overall cardiovascular health of individuals in this age group.
Concluding Thoughts
In conclusion, this study emphasizes the significance of blood pressure variability, both in the short and mid-term, in cognitive functioning and vascular health in older adults. The findings underscore the potential of systolic and diastolic BPV as early clinical markers for cognitive impairment. As the aging population continues to grow, understanding the intricate relationship between blood pressure variability and cognitive health becomes increasingly important for the development of effective preventive and therapeutic strategies. This research offers valuable insights into this complex interplay and opens avenues for further investigation and intervention.
To Summarize
High BPV as a Risk Factor: High blood pressure variability (BPV), particularly in the mid-term, has emerged as a potential independent risk factor for incident dementia in older adults.BPV is more important for cognition and vascular stiffness than circadian and mean BP.
Cognitive Functioning Assessment: A study involving 70 older adults aged 60–80 without dementia used cognitive tests to assess attention, psychomotor speed, and executive functioning, while closely monitoring their blood pressure.
Short-Term and Mid-Term BPV: Both short- and mid-term BPV in systolic and diastolic measurements were linked to poorer cognitive functioning, regardless of mean blood pressure levels. Systolic short-term BPV is positively associated with arterial stiffness in dementia-free adults.
Short-Term BPV and Cognitive Functions: Short-term BPV was specifically associated with attention and psychomotor speed, suggesting that daily fluctuations in blood pressure may impact certain cognitive functions.
Longer-Term BPV and Executive Functioning: Day-to-day BPV was negatively associated with executive functioning, highlighting the impact of variability over a longer time span on higher-order cognitive processes.
Associations are independent of mean BP, age, and antihypertensive treatment.
Journal Reference:
Gutteridge, D., Tully, P., Smith, A., Loetscher, T., & Keage, H. (2023). Cross-sectional associations between short- and mid-term blood pressure variability, cognition, and vascular stiffness in older adults. Cerebral Circulation - Cognition and Behavior, 5, 100181. https://doi.org/10.1016/j.cccb.2023.100181
Related
https://healthnewstrend.com/slow-wave-sleep-loss-may-increase-risk-of-dementia
https://healthnewstrend.com/seasonal-variation-in-blood-pressure-mechanisms-and-management-strategies
https://healthnewstrend.com/hypertension-a-global-challenge-with-promising-new-horizons
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