TY - JOUR
T1 - Long-term blood pressure level and variability from midlife to later life and subsequent cognitive change
T2 - The ARIC neurocognitive study
AU - Yano, Yuichiro
AU - Griswold, Michael
AU - Wang, Wanmei
AU - Greenland, Philip
AU - Lloyd-Jones, Donald M.
AU - Heiss, Gerardo
AU - Gottesman, Rebecca F.
AU - Mosley, Thomas H.
N1 - Funding Information:
The ARIC (Atherosclerosis Risk in Communities) Study is performed as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN26 8201100005C, HHSN268201100006C, HHSN268201100 007C, HHSN268201100008C, HHSN268201100009C, HHS N268201100010C, HHSN268201100011C, and HHSN26 8201100012C). Neurocognitive data are collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01 HL096902, and 2U01HL096917 from the National Institutes of Health (National Heart, Lung, and Blood Institute [NHLBI], National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. The authors thank the staff and participants of the ARIC Study for their important contributions. Yano is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under award P20GM104357. The views expressed in this article are those of the authors and do not necessarily represent the views of the NHLBI, the National Institutes of Health, or the US Department of Health and Human Services. The NHLBI has no role in each of the following: role design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background-To understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change. Methods and Results-The ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1-SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], –0.03 [–0.04 to –0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], –0.02 [–0.03 to –0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], –0.04 [–0.06 to –0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5. Conclusions-Greater visit-to-visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.
AB - Background-To understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change. Methods and Results-The ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1-SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], –0.03 [–0.04 to –0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], –0.02 [–0.03 to –0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], –0.04 [–0.06 to –0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5. Conclusions-Greater visit-to-visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.
KW - Blood pressure
KW - Blood pressure variability
KW - Cognition
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U2 - 10.1161/JAHA.118.009578
DO - 10.1161/JAHA.118.009578
M3 - Article
C2 - 30371241
AN - SCOPUS:85051433675
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e009578
ER -