Visit-to-visit blood pressure variability in the elderly: Associations with cognitive impairment and carotid artery remodeling

Objective: Recently, visit-to-visit blood pressure (BP) variability has been shown to be associated with vascular remodeling and cognitive dysfunction. However, there have been no studies that focused on the relationship between visit-to-visit BP variability and cognitive dysfunction in relation to vascular remodeling. In this study, we investigated the relationships among visit-to-visit BP measures, carotid artery remodeling and cognitive function in the elderly at high risk of cardiovascular disease. Methods: The cognitive function was evaluated using a Mini-Mental State Examination (MMSE) and global deterioration scale (GDS) in 201 elderly subjects at high risk of cardiovascular disease (79.9 +/- 6.4 years old; female 75%). Based on 12 visits (once a month), visit-to-visit BP variability (expressed as the coefficient of variation [CV] and as delta [maximum - minimum] BP) were measured. Carotid ultrasound was performed to measure intima-media thickness (IMT) and the stiffness parameter beta. Results: The patients having both high delta systolic BP (SBP) and high IMT had significantly higher prevalence of low MMSE score than those with both low delta SBP and low IMT (p < 0.05), and the patients having both high delta SBP and high stiffness parameter beta also had significantly higher prevalence of low MMSE score than those with both low delta SBP and low stiffness parameter beta (p < 0.01). In the logistic regression analysis adjusted for age, calcium channel blocker use, low density lipoprotein, average heart rate, and average SBP level, a significant interaction was found between delta SBP and stiffness parameter beta for the low MMSE score (p < 0.05). Conclusions: In the high risk elderly, exaggerated visit-to-visit BP variability and advanced carotid artery remodeling have a synergetic association with cognitive dysfunction. (C) 2013 Elsevier Ireland Ltd. All rights reserved.