2.2 Greater Blood Pressure Variability is Associated with Lower Cognitive Performance — the Maastricht Study

An increasing number of individuals will face age-related cognitive difficulties, as life expectancy has increased globally. It is therefore important to identify modifiable risk factors for cognitive impairment. Very short- to midterm blood pressure variability (BPV) may be such factor, as it may cause cerebral ischemia via various mechanisms. To this end, we investigated whether greater diastolic (dBPV) and systolic BPV (sBPV) are cross-sectionally associated with memory function (MF; n = 1804), information processing speed (IPS; n = 1793), and executive function (EF; n = 1780), in 40- to 75-year-old individuals from The Maastricht Study. A composite BPV-index was derived by standardizing and averaging within-visit, 24-hour and 7-day BPV. We performed linear regression with adjustments for age, sex, educational level, 24-hour DBP or SBP, and cardiovascular risk factors. We found that a 1- SD greater dBPV was associated with lower IPS (beta [SD difference]; 95% CI: −0.10;−0.20 to −0.00) and EF (−0.12; −0.22 to −0.01), and borderline associated with lower MF (−0.09; −0.20 to 0.01). A 1-SD greater sBPV, however, was not associated with IPS (−0.040; −0.14 to 0.06), or EF (−0.09; −0.20 to 0.022), but was borderline associated with lower MF (−0.11; −0.21 to 0.00). This effect of greater dBPV on cognitive performance is equivalent to ±3 additional years of ageing. The stronger association of dBPV than sBPV with cognitive performance may be explained by the fact that DBP is the main determinant of MAP. Excessive dBPV may then lead to inadequate cerebral perfusion. In conclusion, greater very short-to mid-term dBPV and, to a lesser extent, sBPV could be a modifiable risk factor for cognitive impairment.