Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age

Liselotte W. Wijsman, Anton J.M. De Craen, Majon Muller, Behnam Sabayan, David Stott, Ian Ford, Stella Trompet, J. Wouter Jukema, Rudi G.J. Westendorp, Simon P. Mooijaart

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition. METHODS We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition. RESULTS Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (-0.15;-0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function. CONCLUSIONS The association between BP variability and cognitive impairment was not mediated by BPLM.

Original languageEnglish
Pages (from-to)311-318
Number of pages8
JournalAmerican Journal of Hypertension
Volume29
Issue number3
DOIs
Publication statusPublished - 1 Mar 2016

Cite this

Wijsman, Liselotte W. ; De Craen, Anton J.M. ; Muller, Majon ; Sabayan, Behnam ; Stott, David ; Ford, Ian ; Trompet, Stella ; Jukema, J. Wouter ; Westendorp, Rudi G.J. ; Mooijaart, Simon P. / Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age. In: American Journal of Hypertension. 2016 ; Vol. 29, No. 3. pp. 311-318.
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title = "Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age",
abstract = "BACKGROUND Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition. METHODS We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition. RESULTS Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95{\%} confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95{\%} CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (-0.15;-0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95{\%} CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95{\%} CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function. CONCLUSIONS The association between BP variability and cognitive impairment was not mediated by BPLM.",
keywords = "blood pressure, cognition, hypertension, medication, variability",
author = "Wijsman, {Liselotte W.} and {De Craen}, {Anton J.M.} and Majon Muller and Behnam Sabayan and David Stott and Ian Ford and Stella Trompet and Jukema, {J. Wouter} and Westendorp, {Rudi G.J.} and Mooijaart, {Simon P.}",
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Wijsman, LW, De Craen, AJM, Muller, M, Sabayan, B, Stott, D, Ford, I, Trompet, S, Jukema, JW, Westendorp, RGJ & Mooijaart, SP 2016, 'Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age' American Journal of Hypertension, vol. 29, no. 3, pp. 311-318. https://doi.org/10.1093/ajh/hpv101

Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age. / Wijsman, Liselotte W.; De Craen, Anton J.M.; Muller, Majon; Sabayan, Behnam; Stott, David; Ford, Ian; Trompet, Stella; Jukema, J. Wouter; Westendorp, Rudi G.J.; Mooijaart, Simon P.

In: American Journal of Hypertension, Vol. 29, No. 3, 01.03.2016, p. 311-318.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age

AU - Wijsman, Liselotte W.

AU - De Craen, Anton J.M.

AU - Muller, Majon

AU - Sabayan, Behnam

AU - Stott, David

AU - Ford, Ian

AU - Trompet, Stella

AU - Jukema, J. Wouter

AU - Westendorp, Rudi G.J.

AU - Mooijaart, Simon P.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - BACKGROUND Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition. METHODS We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition. RESULTS Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (-0.15;-0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function. CONCLUSIONS The association between BP variability and cognitive impairment was not mediated by BPLM.

AB - BACKGROUND Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition. METHODS We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition. RESULTS Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (-0.15;-0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function. CONCLUSIONS The association between BP variability and cognitive impairment was not mediated by BPLM.

KW - blood pressure

KW - cognition

KW - hypertension

KW - medication

KW - variability

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U2 - 10.1093/ajh/hpv101

DO - 10.1093/ajh/hpv101

M3 - Article

VL - 29

SP - 311

EP - 318

JO - American Journal of Hypertension

JF - American Journal of Hypertension

SN - 0895-7061

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