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Association of higher diastolic blood pressure levels with cognitive impairment

From the Comprehensive Stroke Center (G.T., A.V.A.), Department of Medicine (V.G.W.), Department of Epidemiology (R.C.P.G.), and Department of Biostatistics (G.H.), University of Alabama at Birmingham; Department of Neurology (G.T.), Democritus University of Thrace, University Hospital of Alexandroupolis, Greece; Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (B.K.), University of Cincinnati, OH.

Address correspondence and reprint requests to Dr. Georgios Tsivgoulis, Comprehensive Stroke Center, University of Alabama at Birmingham, RWUH M226, 1530 3rd Avenue S, Birmingham, AL 35294-3280 tsivgoulisgiorg{at}yahoo.gr

Background: We evaluated the cross-sectional relationship of blood pressure (BP) components with cognitive impairment after adjusting for potential confounders.

Methods: Reasons for Geographic and Racial Differences in Stroke (REGARDS) is a national, longitudinal population cohort evaluating stroke risk in 30,228 black and white men and women 45 years old. During the in-home visit, BP measurements were taken as the average of 2 measurements using a standard aneroid sphygmomanometer. Excluding participants with prior stroke or TIA, the present analysis included 19,836 participants (enrolled from December 2003 to March 2007) with complete baseline physical and cognitive evaluations. Incremental logistic models examined baseline relationships between BP components (systolic blood pressure [SBP], diastolic blood pressure [DBP], and pulse pressure [PP]) and impaired cognitive status (score of 4 on 6-Item Screener) after adjusting for demographic and environmental characteristics, cardiovascular risk factors, depressive symptoms, and current use of any antihypertensive medication.

Results: Higher DBP levels were associated with impaired cognitive status after adjusting for demographic and environmental characteristics, risk factors, depressive symptoms, and antihypertensive medications. An increment of 10 mm Hg in DBP was associated with a 7% (95% confidence interval [CI] 1%–14%, p = 0.0275) higher odds of cognitive impairment. No independent association was identified between impaired cognitive status and SBP (odds ratio [OR] 1.02, 95% CI 0.99–1.06) or PP (OR 0.99, 95% CI 0.95–1.04). There was no evidence of nonlinear relationships between any of the BP components and impaired cognitive status. There was no interaction between age and the relationship of impaired cognitive status with SBP (p = 0.827), DBP (p = 0.133), or PP (p = 0.827) levels.

Conclusions: Higher diastolic blood pressure was cross-sectionally and independently associated with impaired cognitive status in this large, geographically dispersed, race- and sex-balanced sample of stroke-free individuals.

Abbreviations: AD = Alzheimer disease; ARIC = Atherosclerosis Risk in Community; BMI = body mass index; BP = blood pressure; CES-D-4 = Center for Epidemiologic Studies-Depression–4-item version; CI = confidence interval; DBP = diastolic blood pressure; IQR = interquartile range; OR = odds ratio; PP = pulse pressure; REGARDS = Reasons for Geographic and Racial Differences in Stroke; SBP = systolic blood pressure.

Supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, NIH, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the NIH. Dr. Tsivgoulis is recipient of a neurosonology fellowship grant from the Neurology Department of Eginition Hospital, University of Athens School of Medicine, Athens, Greece.

Disclosure: Author disclosures are provided at the end of the article.

Received December 17, 2008. Accepted in final form May 22, 2009.

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