The Effect of Hypertension and Baseline Blood Pressure on Cognitive Decline
The Effect of Hypertension and Baseline Blood Pressure on Cognitive Decline
Objectives: To examine the relationship between baseline hypertension, blood pressure, and the development of cognitive decline in participants in the Women's Health Initiative Memory Study (WHIMS).
Design: Prospective analyses.
Setting: Thirty-nine centers.
Participants: Seven thousand one hundred forty-nine women aged 65 and older.
Measurements: The Modified Mini-Mental State Examination (3MS) was used to assess global cognitive functioning. Participants who scored below pre-established cutpoints were scheduled for more-extensive neurocognitive assessments. Results from these assessments were centrally adjudicated.
Results: The mean age of this group of 7,149 participants at baseline was 71.0 ± 3.8, and the mean 3MS score was 95.2 ± 4.3. During a mean follow-up period of 4.5 years, women without hypertension tended to have slightly higher 3MS scores than women with hypertension (P = .001), but the difference was not seen after adjustment for covariates (P = .17). Women with hypertension also appeared to be at greater risk for probable dementia or mild cognitive impairment (MCI) (hazard ratio = 1.35, 95% confidence interval = 1.07–1.70, P = .01), although when potential cofounders were accounted for, this association was no longer significant (P = .06).
Conclusion: Hypertension and high blood pressure at baseline were not independently associated with MCI or probable dementia over time in older, cognitively intact, postmenopausal women enrolled in WHIMS after other potential confounders were taken into account. These analyses should not be viewed as discouraging appropriate medical treatment for hypertension.
Hypertension and cognitive impairment are two common chronic conditions associated with the aging process. The National Center for Health Statistics estimates that the prevalence of hypertension in women aged 65 to 74 is 73.4%. In the United States and Europe, dementia affects 3.6% to 10.3% of the population aged 65 and older, with vascular dementia estimated to be responsible for 10% to 20% of all dementia cases. Alzheimer's disease affects an estimated 4 million Americans. The prevalence of age-associated memory impairment in the general older population is estimated to be 17% to 34%.
The relationship between hypertension and cognitive function has been examined in a number of cross-sectional and longitudinal studies. Although results from these studies have been inconsistent, some prospective observational studies of blood pressure (BP) and cognitive function have found an association between hypertension and decline in cognitive function and development of dementia years later. Several prospective observational studies have also suggested that antihypertensive treatment may be associated with lower risk of the development of cognitive impairment and dementia in elderly people. These observations have prompted evaluations of the efficacy of antihypertensive medication on cognitive impairment in several randomized, placebo-controlled, clinical trials, but these studies have also shown mixed results, with two showing no difference in overall cognitive function or incident dementia, one trial showing lower risk of cognitive decline and dementia only in subjects with recurrent stroke, and one trial showing an overall significant reduction in the incidence of dementia.
Addressing these inconsistencies requires a careful exploration of the relationships between BP and cognitive function while controlling for potential confounders that may affect the association. Using data from the Women's Health Initiative (WHI) Hormone Trial (HT) and the Women's Health Initiative Memory Study (WHIMS), analyses were performed to examine the effects of hypertension, antihypertensive treatment, and baseline BP on cognitive function and on the incidence of probable dementia.
Abstract and Introduction
Abstract
Objectives: To examine the relationship between baseline hypertension, blood pressure, and the development of cognitive decline in participants in the Women's Health Initiative Memory Study (WHIMS).
Design: Prospective analyses.
Setting: Thirty-nine centers.
Participants: Seven thousand one hundred forty-nine women aged 65 and older.
Measurements: The Modified Mini-Mental State Examination (3MS) was used to assess global cognitive functioning. Participants who scored below pre-established cutpoints were scheduled for more-extensive neurocognitive assessments. Results from these assessments were centrally adjudicated.
Results: The mean age of this group of 7,149 participants at baseline was 71.0 ± 3.8, and the mean 3MS score was 95.2 ± 4.3. During a mean follow-up period of 4.5 years, women without hypertension tended to have slightly higher 3MS scores than women with hypertension (P = .001), but the difference was not seen after adjustment for covariates (P = .17). Women with hypertension also appeared to be at greater risk for probable dementia or mild cognitive impairment (MCI) (hazard ratio = 1.35, 95% confidence interval = 1.07–1.70, P = .01), although when potential cofounders were accounted for, this association was no longer significant (P = .06).
Conclusion: Hypertension and high blood pressure at baseline were not independently associated with MCI or probable dementia over time in older, cognitively intact, postmenopausal women enrolled in WHIMS after other potential confounders were taken into account. These analyses should not be viewed as discouraging appropriate medical treatment for hypertension.
Introduction
Hypertension and cognitive impairment are two common chronic conditions associated with the aging process. The National Center for Health Statistics estimates that the prevalence of hypertension in women aged 65 to 74 is 73.4%. In the United States and Europe, dementia affects 3.6% to 10.3% of the population aged 65 and older, with vascular dementia estimated to be responsible for 10% to 20% of all dementia cases. Alzheimer's disease affects an estimated 4 million Americans. The prevalence of age-associated memory impairment in the general older population is estimated to be 17% to 34%.
The relationship between hypertension and cognitive function has been examined in a number of cross-sectional and longitudinal studies. Although results from these studies have been inconsistent, some prospective observational studies of blood pressure (BP) and cognitive function have found an association between hypertension and decline in cognitive function and development of dementia years later. Several prospective observational studies have also suggested that antihypertensive treatment may be associated with lower risk of the development of cognitive impairment and dementia in elderly people. These observations have prompted evaluations of the efficacy of antihypertensive medication on cognitive impairment in several randomized, placebo-controlled, clinical trials, but these studies have also shown mixed results, with two showing no difference in overall cognitive function or incident dementia, one trial showing lower risk of cognitive decline and dementia only in subjects with recurrent stroke, and one trial showing an overall significant reduction in the incidence of dementia.
Addressing these inconsistencies requires a careful exploration of the relationships between BP and cognitive function while controlling for potential confounders that may affect the association. Using data from the Women's Health Initiative (WHI) Hormone Trial (HT) and the Women's Health Initiative Memory Study (WHIMS), analyses were performed to examine the effects of hypertension, antihypertensive treatment, and baseline BP on cognitive function and on the incidence of probable dementia.
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