Systolic Blood Pressure, Cognition, and Race

Summary and Comment |
October 6, 2017

Systolic Blood Pressure, Cognition, and Race

  1. Jennifer Rose V. Molano, MD

Lowering systolic blood pressure to ≤120 mm Hg may benefit cognition.

  1. Jennifer Rose V. Molano, MD

Target systolic blood pressure (SBP) recommendations have ranged from <150 mm Hg for older adults to <120 mm Hg for cardiovascular risk reduction. Black people may have more risks associated with hypertension. To investigate associations among SBP, cognition, and race, researchers analyzed 10-year data from 1657 older adults (mean age, 74 years; 47.3% nonwhite race) receiving hypertension treatment and participating in the Health Aging and Body Composition study. Outcomes included mean scores of global cognition with the Modified Mini-Mental State Examination (3MSE) and a test of visuomotor speed, attention, set-shifting, and memory with the Digit Symbol Substitution Test (DSST).

Mean baseline cognitive scores were 89.8 for the 3MSE and 34.3 for the DSST. The 10-year decrease in adjusted cognitive scores was largest for those with SBP ≥150 mm Hg (−3.7 points on the 3MSE and −6.2 points on the DSST) and smallest for those with SBP ≤120 mm Hg (−3.0 on the 3MSE, −5.0 on the DSST). Compared with white people, black people had lower baseline 3MSE and DSST scores and a greater 10-year decrease in 3MSE scores. Black people had a significantly greater difference than white people in cognitive scores between SBP ≥150 mm Hg and ≥120 mm Hg (−0.08 vs. −0.05 for the 3MSE and −0.13 vs. −0.07 for the DSST).

Comment

Targeting lower blood pressures may slow the cognitive decline in older adults, and SBP ≤120 mm Hg may be a reasonable target for cognition, especially in black people. Replicating these results using more-comprehensive neuropsychological testing and correlating the results with daily functioning would further support more-aggressive blood pressure management to protect cognition.

Editor Disclosures at Time of Publication

  • Disclosures for Jennifer Rose V. Molano, MD at time of publication Editorial boards Neurology Now Leadership positions in professional societies American Academy of Neurology (Meeting Management Committee, Member Engagement Committee)

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