Evaluation of the Effect of Systolic Blood Pressure and Pulse Pressure on Cognitive Function: The Women's Health and Aging Study II

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.Effects 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]).Our 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

Longitudinal Analysis of Hypertension Stages and Pulse Pressure Tertiles on Cognitive Decline.

<p>Reference group for HTN: control group (SBP≤139 mmHg); for PP: pulse pressure lower tertile (48–68 mmHg).</p><p>HTN I = Hypertension I (SBP 140–159 mmHg); HTN II = Hypertension II (SBP≥160); PP middle tertile = Pulse pressure 71–77 mmHg, and PP upper tertile = Pulse pressure 84–108 mmHg.</p><p>Model 1: age, race, education.</p><p>Model 2: age, race, education, history of high blood pressure, stroke, myocardial infarction, congestive heart failure, peripheral artery disease, diabetes mellitus, angina; history of smoking, BMI, ever on hypertensive medication, glucose, cholesterol, and depression score.</p><p>Note: All Trails B models adjust for Trails A performance.</p><p>MMSE = Mini Mental State Exam; TMT, Part A = Trail Making Test, Part A; TMT, Part B = Trail Making Test, Part B; HVLT = Hopkins Verbal Learning Test (HVLT-I = immediate recall; HVLT-D = delayed recall);</p><p>*p-value<0.05.</p><p>**p-value<0.01.</p

Baseline Sociodemographic Characteristics of Participants by Hypertension Status and Pulse Pressure, WHAS II (N = 336).

<p>Control group (SBP≤139 mmHg); HTN I = Hypertension I (SBP 140–159 mmHg); HTN II = Hypertension II (SBP≥160); PP lower tertile = Pulse pressure 48–68 mmHg, PP middle tertile = Pulse pressure 71–77 mmHg, and PP upper tertile = Pulse pressure 84–108 mmHg.</p><p>Statistics = Chi-square test was used for categorical and ANOVA with pairwise comparisons for continuous variables.</p><p>Hx HTN = history of high blood pressure, Hx stroke = history of stroke, Hx MI = history of myocardial infarction, Hx Angina = history of angina, Hx CHF = history of congestive heart failure, Hx PAD = history of peripheral artery disease, Hx DM = history of diabetes mellitus; BMI = Body Mass Index, GDS = Geriatric Depression Scale.</p

Age-stratified Longitudinal Analysis of Hypertension Stages and Pulse Pressure Tertiles on Cognitive Decline.

<p>Reference group for HTN: Control group (SBP≤139 mmHg): for PP: pulse pressure lower tertile (48–68 mmHg).</p><p>HTN Stage I = Hypertension Stage I (SBP 140–159 mmHg); HTN Stage II = Hypertension Satge II (SBP≥160); PP middle tertile = Pulse pressure 71–77 mmHg, and PP upper tertile = Pulse pressure 84–108 mmHg.</p><p>Model 1: age, race, education.</p><p>Model 2: age, race, education, history of high blood pressure, stroke, myocardial infarction, congestive heart failure, peripheral artery disease, diabetes mellitus, angina; history of smoking, BMI, ever on hypertensive medication, glucose, cholesterol, and depression score.</p><p>Note: All Trails B models adjust for Trails A performance.</p><p>MMSE = Mini Mental State Exam; TMT, Part A = Trail Making Test, Part A; TMT, Part B = Trail Making Test, Part B; HVLT = Hopkins Verbal Learning Test (HVLT-I = immediate recall; HVLT-D = delayed recall);</p><p>*p-value<0.05.</p><p>**p-value<0.01.</p

Cross-Sectional Analysis of Hypertension Stages and Pulse Pressure Tertiles on Cognitive Function at Baseline.

<p>Reference group for HTN: control group (SBP≤139 mmHg); for PP: pulse pressure lower tertile (48–68 mmHg).</p><p>HTN I = Hypertension I (SBP 140–159 mmHg); HTN II = Hypertension II (SBP≥160); PP middle tertile = Pulse pressure 71–77 mmHg, and PP upper tertile = Pulse pressure 84–108 mmHg.</p><p>Model 1: age, race, education.</p><p>Model 2: age, race, education, history of high blood pressure, stroke, myocardial infarction, congestive heart failure, peripheral artery disease, diabetes mellitus, angina; history of smoking, BMI, ever on hypertensive medication, glucose, cholesterol, and depression score.</p><p>Note: All Trails B models adjust for Trails A performance.</p><p>MMSE = Mini Mental State Exam; TMT, Part A = Trail Making Test, Part A; TMT, Part B = Trail Making Test, Part B; HVLT = Hopkins Verbal Learning Test (HVLT-I = immediate recall; HVLT-D = delayed recall);</p><p>*p-value<0.05.</p><p>** p-value<0.01.</p

Means (SD) of Performances of Global and Domain Specific Cognitive Function for Exam 1–6 (9-year interval).

<p>MMSE = Mini Mental State Exam; TMT, Part A = Trail Making Test, Part A; TMT, Part B = Trail Making Test, Part B; HVLT = Hopkins Verbal Learning Test (HVLT-I = immediate recall; HVLT-D = delayed recall).</p