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Abstract
BackgroundThe cognitive impact of changes in late-life blood pressure is less clear. We aimed to investigate the association between late-life blood pressure changing pattern and risk of cognitive impairment.MethodsUsing data from the community-based Chinese Longitudinal Healthy Longevity Survey, change in systolic (SBP) or diastolic (DBP) blood pressure was calculated as the difference between follow-up and baseline, cognitive impairment was defined based on both the Mini-Mental State Examination and education level. The generalized additive model with penalized spline and multivariate logistic regression model were used, respectively, to examine the associations between continuous and categorized blood pressure changes with cognitive impairment at the follow-up wave.ResultsA total of 8493 Chinese elderly without cognitive impairment were included, with mean (standard deviation) age 80.6 (10.7) years. U-shaped associations between late-life blood pressure changes and risk of cognitive impairment were found, with only stable optimal blood pressure related to the lowest risk. For participants with baseline SBP around 130–150 mmHg, the adjusted odds ratio was 1.48 (1.13–1.93) for increasing follow-up SBP (> 150 mmHg), 1.28 (1.02–1.61) for decreasing follow-up SBP (< 130 mmHg), compared to stable follow-up SBP (130–150 mmHg). For participants with relative lower baseline DBP (< 80 mmHg), increasing their DBP to 80–90 mmHg during follow-up was associated with lower cognitive impairment risk (0.73 (0.58–0.93)), compared to steady low follow-up DBP (< 80 mmHg). Sex-specific analysis suggested that men were more vulnerable in term of SBP change.ConclusionsAdhering to a stable optimal level of blood pressure in late-life is related to lower risk of cognitive impairment in Chinese elderly.
Highlights
The cognitive impact of changes in late-life blood pressure is less clear
We firstly investigated the associations between changes in blood pressure and risk of cognitive impairment using univariate generalized additive model (GAM) with penalized spline, which could examine the potential non-linear shape
The following proposal was made for covariate control decisions: control for each covariate that is a cause of the exposure, or of the outcome, or of both; exclude from this set any variable known to be an Sensitivity analyses To test the robustness of the main findings, we performed the following analyses: (1) excluding participants with follow-up interval < 2.5 years or > 3.5 years; (2) excluding participants who had self-reported doctordiagnosed hypertension to clarify the potential confounding caused by antihypertensive treatment; (3) using Mini-Mental State Examination (MMSE) decline ≥4 points to define cognitive impairment [22]; and (4) further adjusting for depression at baseline
Summary
The cognitive impact of changes in late-life blood pressure is less clear. We aimed to investigate the association between late-life blood pressure changing pattern and risk of cognitive impairment. The available evidence of late-life blood pressure on cognition is mainly from either cross-sectional studies or prospective cohorts with blood pressure cross-sectionally measured at baseline, limited results about the impact of blood pressure change during follow-up have been reported [8, 9]. The Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national cohort focusing on older Chinese people, is the largest cohort of centenarians in the world with recorded blood pressure information during its follow-up. Using this community-based prospective sample, we examined the associations of changes in latelife blood pressure with cognitive impairment
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