Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

PURPOSE Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged [greater than or equal to] 75 years with or without complex health problems. METHODS We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty. RESULTS Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP 150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend =.013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend CONCLUSIONS Participants aged [greater than or equal to] 75 years undergoing antihypertensive treatment, with SBP [greater than or equal to] 130 mm Hg compared to Key words: hypertension; old age; cognitive function; daily functioning; quality of life
INTRODUCTION Hypertension guidelines recommend lowering systolic blood pressure (SBP) in older patients, but cohort studies have raised concern that lowering SBP too much might harm these patients by, for example, [...]