Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

Background Systolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiov ascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline. Aim To examine associations of IAD with cognitive decline in a community population. Design and setting A prospective study of older Italian adults enrolled In the InCHIANTI study. Method Univariable and multivariable associations of IAD were explored with declines in mini mental state examination [MMSE] scores, Trail Making Test A and B scares. and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline. Results The rate of decline for MMSE scores in 1133 participants was greater with IAD >= 5 mml Ig or >= 10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD. 95% confidence interval [CI] = 122 to 131). Substantial decline in MMSF score was seen with IAD >= 5 mmHg [OR 1.41. 95% CI =1.03 to 1.93), and in the composite outcome with IAD >= 5 mmHg [OR 1.44, 95% CI =1.10 to 129) or >= 10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multwariable adjustment, an IAD >= 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03). Conclusion An IAD >= 5 mmHg is associated with cognitive decline in a representative older population. Gwen that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.