Lower cognitive performance in 81-year-old men with greater nocturnal blood pressure dipping

Abnormal day-to-night blood pressure (BP) pattern have been found to be associated with cerebrovascular damage, yet studies of the elderly 80 years of age and above, for whom the risk pattern may be different due to ageing and age-associated diseases, are lacking. Ninety-seven 81-year-old men underwent ambulatory BP monitoring and were given six cognitive tests, 79 of the men completing the cognitive test battery. The odds ratio (OR) for performing one standard deviation below the mean on any cognitive test was calculated using a forward stepwise logistic regression model, confounding factors being controlled for. Groups defined in terms of day-to-night changes in BP were compared in this respect. Cognitive performance was lower (OR 3.6; P = 0.017) in the group usually described as dippers (10%–20% nocturnal drop in systolic BP [SBP]) as compared with nondippers (<10% drop). The tertile with the greatest SBP fall (10.6%–19.8%, a range considered as normal among middle aged) showed lowest cognitive performance (OR 4.7; P = 0.008) as compared with the middle tertile (5.1%–10.5% drop). The mean nocturnal fall in SBP was 7.4%, significantly greater in those with lower rather than higher cognitive performance. A nocturnal drop in SBP of ≥10% was associated with lower cognitive performance in these elderly men. The limits to normal dipping appear to be shifted in the direction of a lesser drop in the very elderly

Hypertension, blood pressure, cognition and cerebral blood flow in the cohort of "Men born 1914"

"Men born 1914" is a population based cohort study of the epidemiology of cardiovascular disease. Five hundred men, born 1914, were examined at the age of 68 and 185 of them were re-examined at 81 years of age. Examination included a medical and a psychological investigation, ultrasonographic measurement of carotid arteries, 24-hour ambulatory blood pressure monitoring, regional cerebral blood flow, and cardiovascular risk factors. It is well known that hypertension plays a major etiological role in the development of cerebrovascular disease, ischemic heart disease, and cardiac failure. High blood pressure has often been discussed as a risk factor in regard to cerebrovascular disorders and even vacular dementia and over the years much research has been performed to study elevated blood pressure, its treatment and prevention. Active treatment of hypertension substantially reduces the risk of these complications. However, very little attention has been paid to low blood pressure and diurnal variation of blood pressure in the elderly. It is well known that a fall in blood pressure may lead to cerebral hypoperfusion and might be of importance in the development of cerebrovascular insufficiency, i.e. those in which the cerebral blood flow is inadequate in relation to the metabolic needs of the brain tissue. The resultant decrease in the cerebral blood flow gives rise to ischemic hypoxia. Study I showed, that hypertension is a potential risk factor for the development of carotid artery stenosis (CAS). 93% of the surviving study cohort had CAS at 81 years of age. Study II showed, that high blood pressure at baseline examination, especially DBP and decrease of DBP, was inversely related to speed performance and spatial functions in psychometric tests taken 13 years later. Study III showed significant associations between blood pressure (BP) levels and cerebral blood flow (CBF), especially at night. The noted association between rCBF and low BP might indicate an increased risk for nocturnal cerebral ischemia. Study IV showed, that extreme blood pressure fall at night in a cohort of elderly men is associated with focal changes in cerebral perfusion. This could be correlated with increasing blood pressure over a long time and result in damage of vascular autoregulation

Incidence and progression of carotid artery stenosis in elderly men : Thirteen-year follow-up of the population cohort 'Men born in 1914'

'Men born in 1914' is a population-based cohort study of the epidemiology of cardiovascular disease. Twenty-five percent of the men had moderate or severe (> 30%) carotid artery stenosis (CAS) at 68 years of age. The objective of this study was to study the incidence and progression of disease from 68 to 81 years of age in relation to major risk factors for atherosclerotic disease. Five hundred men, born 1914, were examined at the age of 68, and 185 of them were re-examined at 81 years of age. Examination included ultrasonographic measurement of carotid arteries and cardiovascular risk factors. The ultrasonographic examinations of the carotid arteries were made with the continuous-wave doppler method at 68 years of age and with the duplex method at 81 years of age. Two hundred and nineteen men died and 95 were unwilling to participate in the follow-up. Twenty-three percent of these men had been treated for stroke and 13.7% died from ischaemic heart disease. Of the 185 men who were re-examined, 148 had normal carotid artery blood flow at the age of 68, while 37 men had CAS. At follow-up, only 12 of the 148 men still had no signs of CAS, while 136 men (91.2%) had developed CAS by the age of 81 and the incidence of stroke was 8.0/1000 person years. Less than 10% of the 37 men with CAS at 68 years of age developed a high degree of stenosis (>70%). A higher proportion of hypertension was noted in men who developed bilateral CAS, 64.8% (n = 105), compared to the others, 39.5% (n = 43), p < 0.005. Less hypertension was noted in men with unilateral CAS (n = 31) than in men with bilateral CAS (n = 105), the figures being 35% and 65%, respectively, p < 0.013. No significant differences were noted for other cardiovascular risk factors. The development of CAS increases with age and hypertension emerges as a potential risk factor

Low ambulatory blood pressure is associated with lower cognitive function in healthy elderly men.

INTRODUCTION: Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however. METHODS: Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors. RESULTS: Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.). CONCLUSION: Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age

Low nocturnal blood pressure is associated with reduced cerebral blood flow in the cohort "Men born in 1914"

BACKGROUND: Men born in 1914 is a population-based cohort study of the epidemiology of cardiovascular and cerebral disease. Little is known about how diurnal variation in blood pressure (BP) levels influence cerebral perfusion in very elderly populations. OBJECTIVES: To study the association between systolic (SBP) and diastolic BP (DBP) levels, during the day and at night, expressed through 24 h ambulatory BP monitoring (ABPM) and regional cerebral blood flow (rCBF) disturbances. METHODS: A cross-sectional study from a population-based cohort of 108 men 81 years of age (born in 1914) was performed in an outpatient university clinic. Cerebral blood flow measurements using 99mTc- hexamethylpropyleneamine oxime single photon emission computed tomography and 24 h ABPM were performed. Eleven men were excluded due to incomplete ABPM data. RESULTS: Mean DBP at night for each tertile was correlated to rCBF for the medial temporal right (P=0.012) and left (P=0.039) regions. Also, DBP during the day was correlated to the medial temporal right region (P=0.025). When analyses were stratified for DBP during the day, subjects with high DBP during the day (greater than 70 mmHg) showed a stronger association between low medial temporal right rCBF and low mean DBP at night (r=0.32, P=0.009) compared with subjects who had a lower daytime DBP. A corresponding positive correlation was noted for the medial temporal left region and daytime SBP, whereas a negative correlation was noted for frontal left region blood flow and SBP at night. CONCLUSIONS: A significant association was seen between low BP levels, especially at night, and rCBF in subjects with otherwise normal daytime DBP that may indicate a risk for nocturnal cerebral ischemia. Blood pressure monitoring; Cerebral autoregulation; Cohort study; Nocturnal blood pressure, Regional cerebral blood flow

Cerebral perfusion in the elderly with nocturnal blood pressure fall

Cerebrovascular disease may be linked with vascular autoregulation in aging. The aim of this study was to examine relation between nocturnal blood pressure (BP) fall and cerebral blood flow (CBF) changes in elderly men. The prospective 'Men born in 1914' cohort study has been in progress since 1968 and included 809 subjects. After 14 years from the last follow up, 97 subjects reached the age of 82 and underwent CBF measurement and 24 h ambulatory blood pressure monitoring. Diastolic BP at night decreased in 84 subjects with median 12.7% and increased in 13 subjects with median 3.7%. Relative diastolic BP fall at night was negatively associated to CBF in temporal and infero-parietal areas. Higher proportion of subjects with increasing systolic BP during the 14-year period was observed in the subgroup with extreme nocturnal diastolic BP dip, irrespectively of BP values or prevalence of hypertension. Extreme nocturnal diastolic BP fall in a cohort of elderly men is correlated with focal changes in CBF. Further studies could explain if increasing BP in the elderly is a cause or result of pathological autoregulation, and if antihypertensive treatment increases nocturnal BP dip

Hypertension and changes of cognitive function in 81-year-old men: a 13-year follow-up of the population study 'Men born in 1914', Sweden

Background The relationship between blood pressure levels and decline of cognition has been discussed previously, but little is known about the confounding effect of lifestyle factors, anti hypertensive treatment and disease in the elderly. Objective To examine the association between systolic (SBP) and diastolic (DBP) blood pressure, changes of DBP and SBP and hypertension (HT) on cognitive function, while controlling for confounding factors. Design A longitudinal cohort study of men born in 1914 and residing in the municipality of Malmo studied at age 68 and 81 years. Setting Probands invited to a university clinic. Subjects One hundred and eighty-six out of 281 invited men still alive in 1995/6 participated in the most recent follow-up. Main outcome Change of the cognitive performance in the verbal (Paired Associates and Synonyms), spatial (Block Design and Benton Visual Retention test) and speed (Digit Symbol Substitution) functions. Results DBP by tertiles at 68 years, but not HT, was inversely related to verbal, spatial and speed performance at 81 years. Only spatial function was related to SBP at 68 years. The association between DBP and SBP by tertiles, and spatial functions (Block Design and Benton Visual Retention test) remained after controlling for education, marital status, smoking, alcohol and physical activity, and intermediates such as arteriosclerotic manifestations (block design, beta = -0.17; P = 0.029) in multiple regression models. A decrease in DBP was likewise related to spatial (beta = 0.16; P = 0.049) and speed performance (beta = 0.17; P = 0.039) in the same regression model. Conclusions Evidence is found to support the hypothesis that hypertension, especially high DBP in late midlife, is associated with a decline in spatial performance of cognitive functions in elderly men. (C) 2003 Lippincott Williams Wilkins

Smoking-Related Changes in Cerebral Perfusion in a Population of Elderly Men.

Aim: Smoking and hypertension are known causes of stroke and dementia. This study was designed to test the longitudinal effect of lifestyle factors and hypertension on cerebral blood flow (CBF) in old age. Method: A study of an unselected population cohort of 703 men, born in 1914, has been in progress since 1968 and the last clinical examination occurred at age 69. CBF was examined in 129 survivors who reached 82 years, using SPECT. Results: At the age of 69, the study subjects consisted of 36 smokers, 37 nonsmokers and 56 former smokers who had quit. Fourteen years later, there were no differences in CBF among them. The cohort was stratified into 69 hypertensive and 60 normotensive men. CBF in normotensives was lowest in smokers and highest in nonsmokers. No CBF differences were observed in hypertensive men regarding smoking, but their CBF was as low as in normotensive smokers. Hypertensives had a higher BMI, and higher blood glucose and triglyceride levels, but lower alcohol consumption at 69 and a lower ankle-brachial pressure index at 82 years. Alcohol consumption was highest in normotensive smokers. Conclusion: Smoking and high alcohol consumption in normotensive men are correlated to low CBF in senescence. Low CBF in hypertensive men regardless of smoking may be due to a high vascular risk profile. Copyright (c) 2008 S. Karger AG, Basel