Systolic Blood Pressure and Cognition in the Elderly: The Northern Manhattan Study¹

Article type: Research Article

Authors: Sun, Xiaoyan^{a; b; 2; *} | Dong, Chuanhui^{a; b; 2} | Levin, Bonnie E.^{a; b} | Caunca, Michelle^{a; b} | Zeki Al Hazzourie, Adina^c | DeRosa, Janet T.^d | Stern, Yaakov^d | Cheung, Ying Kuen^e | Elkind, Mitchell S.V.^{c; d} | Rundek, Tatjana^{a; b} | Wright, Clinton B.^f | Sacco, Ralph L.^{a; b}

Affiliations: [a] Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA | [b] Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA | [c] Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA | [d] Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA | [e] Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA | [f] National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

Correspondence: [*] Correspondence to: Xiaoyan Sun, MD, PhD, 1120 NW 14th St, CRB 1343, Miami, FL 33136, USA. E-mail: XXS356@med.miami.edu.

Note: [1] This article received a correction notice (Erratum) with the reference: 10.3233/JAD-219015, available at https://content.iospress.com/articles/journal-of-alzheimers-disease/jad219015.

Note: [2] These authors contributed equally to this study.

Abstract: Background:Increasing evidence suggests that hypertension is a risk factor for cognitive impairment and dementia. The relationship between blood pressure and cognition in a racially and ethnically diverse population remains unclear. Objective:To study association of blood pressure with cognition cross-sectionally and longitudinally in the elderly. Methods:Participants are stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (NOMAS) (n = 1215). General linear models are constructed to examine blood pressure in relation to cognition cross-sectionally and longitudinally at a five-year follow-up. Results:We found a cross-sectional association of systolic blood pressure (SBP) with word fluency/semantic memory, executive function, and processing speed/visual motor integration (VMI) function. This association was independent of demographics, vascular risk factors, white matter hyperintensity volume (WMHV), and carotid intima-media thickness (cIMT). The cross-sectional association of SBP with processing speed/VMI and executive function was attenuated after adjusting anti-hypertension medications in the models. Baseline SBP was associated with the change of processing speed/VMI function after adjusting vascular risk factors, WMHV, and cIMT at a 5-year follow-up. This longitudinal association was not found after adjusting anti-hypertension medications in the models. Further analyses revealed that individuals with category SBP from < 120 mmHg to≥140 mmHg had a linear decline in processing speed/VMI function at a 5-year follow-up. Conclusion:We show that SBP is negatively associated with cognition cross-sectionally and longitudinally in the elderly. Anti-hypertension treatment eliminates the negative association of SBP with processing speed/VMI function longitudinally. Our findings support the treatment of stage 1 systolic hypertension in the elderly.

Keywords: Cognition, northern manhattan study (NOMAS), race/ethnicity, systolic blood pressure

DOI: 10.3233/JAD-210252

Journal: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 689-699, 2021