Abstract
BackgroundEvidence suggests that elevated systolic blood pressure (SBP) and pulse pressure (PP) in midlife is associated with increased risk for cognitive impairment later in life. There is mixed evidence regarding the effects of late life elevated SBP or PP on cognitive function, and limited information on the role of female gender.Methods/Principal FindingsEffects of SBPand PPon cognitive abilities at baseline and over a 9-year period were evaluated in 337 non-demented community-dwelling female participants over age 70 in the Women's Health and Aging Study II using logistic and Cox proportional hazards regression analyses. Participants aged 76–80 years with SBP≥160 mmHg or PP≥84 mmHg showed increased incidence of impairment on Trail Making Test-Part B (TMT, Part B), a measure of executive function, over time when compared to the control group that included participants with normal and pre-hypertensive SBP (<120 and 120–139 mmHg) or participants with low PP (<68 mmHg) (HR = 5.05 [95%CI = 1.42, 18.04], [HR = 5.12 [95%CI = 1.11; 23.62], respectively). Participants aged 70–75 years with PP≥71 mmHg had at least a two-fold higher incidence of impairment on HVLT-I, a measure of verbal learning, over time when compared to participants with low PP (<68 mmHg) (HR = 2.44 [95%CI = 1.11, 5.39]).Conclusions/SignificanceOur data suggest that elevated SBP or PP in older non-demented women increases risk for late-life cognitive impairment and that PP could be used when assessing the risk for impairment in cognitive abilities. These results warrant further, larger studies to evaluate possible effects of elevated blood pressure in normal cognitive aging.
Highlights
Hypertension (HTN), an elevation of systolic or diastolic or both systolic and diastolic blood pressures, is an important public health issue because of its high prevalence, approximately 26% in the general population [1], and because of associated high morbidity and mortality [2]
In this study we evaluated effects of elevated systolic blood pressure (SBP) or pulse pressure (PP) on cognitive abilities, such as global cognitive function, speed of processing, executive function, visuospatial function, and verbal learning and memory, at baseline and over a 9-year period in nondemented older community-dwelling female participants, in the Women’s Health and Aging Study (WHAS) II
Our results showed that women aged between 76–80 years with SBP$160 mmHg or with PP$84 mmHg showed five times higher incidence of impairment on Trail Making Test (TMT), Part B, a measure of executive function, when compared to their control groups
Summary
Hypertension (HTN), an elevation of systolic or diastolic or both systolic and diastolic blood pressures, is an important public health issue because of its high prevalence, approximately 26% in the general population [1], and because of associated high morbidity and mortality [2]. There is evidence that age-related blood pressure changes occur and that these changes are gender-specific, namely systolic hypertension is more prevalent in elderly women than men [3] These age-related blood pressure changes may account, in part, for the higher cardiovascular mortality reported among elderly females compared with elderly males [4,5,6], and should be considered an important target for preventive strategies in elderly females. While there is strong evidence that HTN in midlife is associated with increased risk for cognitive impairment later in life [8,9,10,11,12,13], there is mixed evidence regarding the effects of HTN in late life on cognitive function. Evidence suggests that elevated systolic blood pressure (SBP) and pulse pressure (PP) in midlife is associated with increased risk for cognitive impairment later in life. There is mixed evidence regarding the effects of late life elevated SBP or PP on cognitive function, and limited information on the role of female gender
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