24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

ABSTRACT

Blood pressure variability is a risk factor for dementia, even when mean blood pressure levels are rigorously controlled. This study aimed to investigate the effect of ambulatory blood pressure variability on cognitive outcomes under intensive vs standard blood pressure lowering.

DESIGN

Post hoc analysis of the Systolic Blood Pressure Intervention Trial clinical trial.

PARTICIPANTS

793 participants at increased risk for cardiovascular disease without a history of dementia.

INTERVENTION

Standard (<140 mmHg systolic blood pressure target) vs intensive (<120 mmHg systolic blood pressure target) lowering of mean blood pressure.

MEASUREMENTS

24-hour ambulatory blood pressure monitoring and follow-up cognitive testing. Intraindividual blood pressure variability was calculated, and participants were categorized into three clinical outcomes: no cognitive impairment, mild cognitive impairment, probable dementia.

RESULTS

Higher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard group but not in the intensive group. Similar findings were observed with daytime systolic blood pressure variability but not nighttime blood pressure variability. Mean blood pressure was not associated with cognitive outcomes.

CONCLUSIONS

Higher systolic 24-hour and daytime blood pressure variability via ambulatory monitoring is associated with risk for dementia under standard blood pressure treatment. These findings support prior evidence that blood pressure variability remains a risk for dementia despite strict control of mean blood pressure levels.

PMID:38706284 | DOI:10.14283/jpad.2024.35

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