Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment: A Community-Based Prospective Cohort Study

Jin Qiu Yuan, Yue Bin Lv, Hua Shuai Chen, Xiang Gao, Zhao Xue Yin, Wen Tao Wang, Virginia Byers Kraus, Jie Si Luo, Jiao Nan Wang, Yi Zeng, Chen Mao, Xiao Ming Shi

Research output: Contribution to journalArticle

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Abstract

Objectives: To investigate the association between late-life blood pressure and the incidence of cognitive impairment in older adults. Design: Prospective cohort study. Setting: Community-living older adults from 22 provinces in China. Participants: We included 12,281 cognitively normal [Mini-Mental State Examination (MMSE) ≥ 24] older adults (median age: 81 years) from the Chinese Longitudinal Healthy Longevity Survey. Eligible participants must have baseline blood pressure data and have 1 or more follow-up cognitive assessments. Measurements: Baseline systolic (SBP) and diastolic blood pressure (DBP) were measured by trained internists. Cognitive function was evaluated by MMSE. We considered mild/moderate/severe cognitive impairment (MMSE <24, and MMSE decline ≥3) as the primary outcome. Results: The participants with hypertension had a significantly higher risk of mild/moderate/severe cognitive impairment (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.10-1.24). Overall, the associations with cognitive impairment seem to be hockey stick–shaped for SBP and linear for DBP, though the estimated effects for low SBP/DBP were less precise. High SBP was associated with a gradual increase in the risk of mild/moderate/severe cognitive impairment (P trend <.001). Compared with SBP 120 to 129 mmHg, the adjusted HR was 1.17 (95% CI 1.07-1.29) for SBP 130 to 139 mmHg, increased to 1.54 (95% CI 1.35-1.75) for SBP ≥180 mmHg. Analyses for high DBP showed the same increasing pattern, with an adjusted HR of 1.09 (95% CI 1.01-1.18) for DBP 90 to 99 mmHg and 1.19 (95% CI 1.02-1.38) for DBP ≥110 mmHg, as compared with DBP 70 to 79 mmHg. Conclusion: Late-life high blood pressure was independently associated with cognitive impairment in cognitively normal Chinese older adults. Prevention and management of high blood pressure may have substantial benefits for cognition among older adults in view of the high prevalence of hypertension in this rapidly growing population.

Original languageEnglish (US)
Pages (from-to)177-182.e2
JournalJournal of the American Medical Directors Association
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Cohort Studies
Prospective Studies
Blood Pressure
Incidence
Confidence Intervals
Hypertension
Cognitive Dysfunction
Cognition
Hockey
China

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Yuan, Jin Qiu ; Lv, Yue Bin ; Chen, Hua Shuai ; Gao, Xiang ; Yin, Zhao Xue ; Wang, Wen Tao ; Kraus, Virginia Byers ; Luo, Jie Si ; Wang, Jiao Nan ; Zeng, Yi ; Mao, Chen ; Shi, Xiao Ming. / Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment : A Community-Based Prospective Cohort Study. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 2. pp. 177-182.e2.
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title = "Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment: A Community-Based Prospective Cohort Study",
abstract = "Objectives: To investigate the association between late-life blood pressure and the incidence of cognitive impairment in older adults. Design: Prospective cohort study. Setting: Community-living older adults from 22 provinces in China. Participants: We included 12,281 cognitively normal [Mini-Mental State Examination (MMSE) ≥ 24] older adults (median age: 81 years) from the Chinese Longitudinal Healthy Longevity Survey. Eligible participants must have baseline blood pressure data and have 1 or more follow-up cognitive assessments. Measurements: Baseline systolic (SBP) and diastolic blood pressure (DBP) were measured by trained internists. Cognitive function was evaluated by MMSE. We considered mild/moderate/severe cognitive impairment (MMSE <24, and MMSE decline ≥3) as the primary outcome. Results: The participants with hypertension had a significantly higher risk of mild/moderate/severe cognitive impairment (hazard ratio [HR] 1.17, 95{\%} confidence interval [CI] 1.10-1.24). Overall, the associations with cognitive impairment seem to be hockey stick–shaped for SBP and linear for DBP, though the estimated effects for low SBP/DBP were less precise. High SBP was associated with a gradual increase in the risk of mild/moderate/severe cognitive impairment (P trend <.001). Compared with SBP 120 to 129 mmHg, the adjusted HR was 1.17 (95{\%} CI 1.07-1.29) for SBP 130 to 139 mmHg, increased to 1.54 (95{\%} CI 1.35-1.75) for SBP ≥180 mmHg. Analyses for high DBP showed the same increasing pattern, with an adjusted HR of 1.09 (95{\%} CI 1.01-1.18) for DBP 90 to 99 mmHg and 1.19 (95{\%} CI 1.02-1.38) for DBP ≥110 mmHg, as compared with DBP 70 to 79 mmHg. Conclusion: Late-life high blood pressure was independently associated with cognitive impairment in cognitively normal Chinese older adults. Prevention and management of high blood pressure may have substantial benefits for cognition among older adults in view of the high prevalence of hypertension in this rapidly growing population.",
author = "Yuan, {Jin Qiu} and Lv, {Yue Bin} and Chen, {Hua Shuai} and Xiang Gao and Yin, {Zhao Xue} and Wang, {Wen Tao} and Kraus, {Virginia Byers} and Luo, {Jie Si} and Wang, {Jiao Nan} and Yi Zeng and Chen Mao and Shi, {Xiao Ming}",
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Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment : A Community-Based Prospective Cohort Study. / Yuan, Jin Qiu; Lv, Yue Bin; Chen, Hua Shuai; Gao, Xiang; Yin, Zhao Xue; Wang, Wen Tao; Kraus, Virginia Byers; Luo, Jie Si; Wang, Jiao Nan; Zeng, Yi; Mao, Chen; Shi, Xiao Ming.

In: Journal of the American Medical Directors Association, Vol. 20, No. 2, 01.02.2019, p. 177-182.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment

T2 - A Community-Based Prospective Cohort Study

AU - Yuan, Jin Qiu

AU - Lv, Yue Bin

AU - Chen, Hua Shuai

AU - Gao, Xiang

AU - Yin, Zhao Xue

AU - Wang, Wen Tao

AU - Kraus, Virginia Byers

AU - Luo, Jie Si

AU - Wang, Jiao Nan

AU - Zeng, Yi

AU - Mao, Chen

AU - Shi, Xiao Ming

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objectives: To investigate the association between late-life blood pressure and the incidence of cognitive impairment in older adults. Design: Prospective cohort study. Setting: Community-living older adults from 22 provinces in China. Participants: We included 12,281 cognitively normal [Mini-Mental State Examination (MMSE) ≥ 24] older adults (median age: 81 years) from the Chinese Longitudinal Healthy Longevity Survey. Eligible participants must have baseline blood pressure data and have 1 or more follow-up cognitive assessments. Measurements: Baseline systolic (SBP) and diastolic blood pressure (DBP) were measured by trained internists. Cognitive function was evaluated by MMSE. We considered mild/moderate/severe cognitive impairment (MMSE <24, and MMSE decline ≥3) as the primary outcome. Results: The participants with hypertension had a significantly higher risk of mild/moderate/severe cognitive impairment (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.10-1.24). Overall, the associations with cognitive impairment seem to be hockey stick–shaped for SBP and linear for DBP, though the estimated effects for low SBP/DBP were less precise. High SBP was associated with a gradual increase in the risk of mild/moderate/severe cognitive impairment (P trend <.001). Compared with SBP 120 to 129 mmHg, the adjusted HR was 1.17 (95% CI 1.07-1.29) for SBP 130 to 139 mmHg, increased to 1.54 (95% CI 1.35-1.75) for SBP ≥180 mmHg. Analyses for high DBP showed the same increasing pattern, with an adjusted HR of 1.09 (95% CI 1.01-1.18) for DBP 90 to 99 mmHg and 1.19 (95% CI 1.02-1.38) for DBP ≥110 mmHg, as compared with DBP 70 to 79 mmHg. Conclusion: Late-life high blood pressure was independently associated with cognitive impairment in cognitively normal Chinese older adults. Prevention and management of high blood pressure may have substantial benefits for cognition among older adults in view of the high prevalence of hypertension in this rapidly growing population.

AB - Objectives: To investigate the association between late-life blood pressure and the incidence of cognitive impairment in older adults. Design: Prospective cohort study. Setting: Community-living older adults from 22 provinces in China. Participants: We included 12,281 cognitively normal [Mini-Mental State Examination (MMSE) ≥ 24] older adults (median age: 81 years) from the Chinese Longitudinal Healthy Longevity Survey. Eligible participants must have baseline blood pressure data and have 1 or more follow-up cognitive assessments. Measurements: Baseline systolic (SBP) and diastolic blood pressure (DBP) were measured by trained internists. Cognitive function was evaluated by MMSE. We considered mild/moderate/severe cognitive impairment (MMSE <24, and MMSE decline ≥3) as the primary outcome. Results: The participants with hypertension had a significantly higher risk of mild/moderate/severe cognitive impairment (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.10-1.24). Overall, the associations with cognitive impairment seem to be hockey stick–shaped for SBP and linear for DBP, though the estimated effects for low SBP/DBP were less precise. High SBP was associated with a gradual increase in the risk of mild/moderate/severe cognitive impairment (P trend <.001). Compared with SBP 120 to 129 mmHg, the adjusted HR was 1.17 (95% CI 1.07-1.29) for SBP 130 to 139 mmHg, increased to 1.54 (95% CI 1.35-1.75) for SBP ≥180 mmHg. Analyses for high DBP showed the same increasing pattern, with an adjusted HR of 1.09 (95% CI 1.01-1.18) for DBP 90 to 99 mmHg and 1.19 (95% CI 1.02-1.38) for DBP ≥110 mmHg, as compared with DBP 70 to 79 mmHg. Conclusion: Late-life high blood pressure was independently associated with cognitive impairment in cognitively normal Chinese older adults. Prevention and management of high blood pressure may have substantial benefits for cognition among older adults in view of the high prevalence of hypertension in this rapidly growing population.

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