Fluctuating blood pressure in older men — particularly older Black men — is tied to a heightened risk of cognitive decline.
Previous
research showed that blood pressure variability is linked to poorer thinking
skills in white people.
- A
new study extends these findings by examining the link in both white and
Black people and compares the two groups.
- They
show that this relationship is most pronounced in older Black men.
A recent study, which
appears in the journal Neurology, focuses on thinking skills and blood pressure
variability — in other words, how much blood pressure changes between visits to
the doctor’s office.
The research team that conducted this study found
that individuals with the highest variation in blood pressure over 18 years had
the poorest scores in cognitive tests.
The relationship was
most pronounced in older Black men, equating to an extra 2.8 years of cognitive
aging in those with the most variable blood pressure.
How does
blood pressure affect cognitive decline?
As people age, thinking
skills tend to slow. This cognitive decline, however, is not inevitable, and it
affects some people more than others.
Because the average age
of the population is slowly increasing and the proportion of older adults in
society grows, understanding the risk factors for cognitive decline is
important.
Already, scientists have identified that high blood pressure, or
hypertension, increases the risk.of cognitive
decline. Conversely, treatment of hypertension seems to reduce the risk.
More recently, scientists
have also shown that blood pressure variability. may be
a better predictor of cognitive decline than average blood pressure readings.
However, most of the
research to date recruited mostly white people. That being the case, there is
an urgent need to understand how this relationship plays out in Black people.
This is because, as the authors of the new study
explain in their paper, “compared with white older adults, Black individuals
experience a more significant burden of cardiovascular risk factors,
particularly hypertension.”
They write that this is
likely due to a number of factors known as social determinants of health, which
can include access to healthcare, socioeconomic status, and health literacy.
Black people
with fluctuating blood pressure face higher cognitive decline risk
To investigate, the
scientists who conducted the recent study took data from the Chicago Health and Aging Project, which included 4,770
individuals aged 65 or older (average age of 71.3). Of these, 66% were Black
and the rest white.
These people were
followed for 18 years and had their blood pressure measured every 3 years. They
also completed four cognitive tests.
The researchers found
that, on average, Black participants had more existing health conditions and
were involved in less physical and cognitive activities. They were also more
likely to be smokers.
To
understand how they calculated blood pressure variability, below is a quick
example using the systolic blood pressure readings
of one participant with three checkups:
- visit 1: 145 millimeters of mercury (mm Hg)
- visit 2: 160 mm Hg
- visit 3: 150 mm Hg.
The difference between
the first and second visit is 15 mm Hg, and the difference between the second
and third is of 10 mm Hg. The two differences are then averaged which gives a
mean difference of 12.5 mm Hg.
The scientists found
that, on average, Black people had systolic blood pressure variability of 17.7
mm Hg, compared with 16 mm Hg for white participants.
During their analysis,
they split the participants into three groups — high, medium, and low blood
pressure variation. They found that, overall, those in the high variability
group had lower cognitive scores at their last visit.
For Black people, specifically, those in the high
variability group had lower scores on the cognitive tests equivalent to 2.8
extra years of cognitive aging.
For white people,
although the relationship was in the same direction, it was less pronounced and
the results did not reach statistical significance.
Interestingly, the researchers
also found that the associations were “independent of systolic and diastolic
blood pressure.” This means that even in individuals with relatively healthy
blood pressure, the variation alone appears to be a risk factor for cognitive
decline.
Controlling
blood pressure can mitigate cognitive decline risk
“With our aging society
and the prevalence of Alzheimer’s disease, identifying prevention strategies to
slow the decline of cognitive skills in older adults has become a public health
priority,” explained study author Anisa Dhana,
MD, from Rush University in Chicago, IL, in a press release.
“Managing blood pressure
and its fluctuations is emerging as an essential risk factor that can be
modified,” she added.
Another important finding was that blood pressure
variation was not linked to cognitive decline for individuals who were taking
blood pressure medication. However, research shows that Black people with
hypertension are less likely. to be taking medication.
As mentioned, many
factors likely influence cardiovascular risk in Black populations, but the
authors hope that their findings “increase awareness in developing
race-specific pharmacologic and nonpharmacologic treatment plans.”
José Morales, MD is a vascular neurologist and
neurointerventional surgeon at Providence Saint John’s Health Center in Santa
Monica, CA, not involved in the current study.
Speaking to Medical
News Today, he commented on whether blood pressure variation could one day
be used as an early warning sign for cognitive decline risk.
“Absolutely [it could],
but the tools to monitor these phenomena are still being developed,” he told
us. “I suspect that the more dynamic variations throughout a given day may
truly underly the mechanisms suspected to cause end-organ damage.”
“Newer technology that
allows for continuous blood pressure monitoring will be key to truly
understanding ways to mitigate the harmful effects of hypertension,” Morales
concluded.
How to
maintain a healthy blood pressure
As evidence mounts that
hypertension is linked to cognitive decline, Alan
Rozanski, MD, professor of medicine at the Icahn School of Medicine
at Mount Sinai, who was not involved in the current study, offered some tips on
how to maintain a healthy blood pressure.
He suggested:
1. Limiting intake of highly processed foods: “These can raise LDL or ‘bad’ cholesterol in
multiple ways. Specifically, it’s important to limit or avoid fried foods like
French fries and onion rings, processed meats such as bacon, sausage, hot dogs,
and salami, as well as commercial baked goods like cookies, cakes, pastries,
and doughnuts.”
2. Reducing excessive sodium intake: “There is some debate as to the ideal amount of
sodium to consume in one’s diet, but most health organizations agree that
excessive sodium intake — well above 2,300 milligrams per day — raises the risk
of high blood pressure and heart disease. “
3. Getting regular exercise: “Regular exercise helps raise HDL ‘good’
cholesterol, lower LDL cholesterol and triglycerides, and improve how your body
uses fat.”
4. Managing stress levels: “Stress is a common part of life, but it becomes
harmful when it leads to high emotional distress, feels uncontrollable, or
persists at a high level over time. Try deep breathing, meditation, exercise,
hobbies, spending time in nature, or seeking support from friends or
counselors.”
5. Getting your blood pressure checked regularly: “Too many individuals have unrecognized high
blood pressure. The sooner you know that you have this, the earlier you can
institute healthy lifestyle changes that may help to lower your blood
pressure.”
Study limitations
The authors do
acknowledge certain limitations to their study. For instance, because their
study was conducted on participants in the south side of Chicago, the results
may not be applicable to other regions or ethnic backgrounds.
Morales told MNT that
these results support previous work, but because “the blood pressure
measurements for this study are spread over pretty large intervals (i.e.,
years), there are likely to be confounding factors when looking at such complex
pathophysiology.”
In conclusion, the
authors recommend routine assessment for blood pressure in Black people to help
identify and potentially reverse cognitive decline.
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