Subvert cognition!

*For medical professionals only for reference blood pressure management "lower is better" does not apply to the elderly It is well known that high blood pressure hurts the brain! And studies have long confirmed that high blood pressure in young people is more susceptible to Alzheimer's disease (commonly known as "senile dementia") in old age [1]
.

However, the extent to which blood pressure should be controlled in older adults to prevent dementia is unclear
.

A recent cohort study [2] published in JAMA Intern Med showed that older adults with higher systolic blood pressure (SBP) levels had a lower risk of dementia
.

Figure 1: Research published in JAMA Intern Med subverts cognition, the elderly with high blood pressure have a lower risk of dementia! This study pooled data from seven prospective, observational, population-based cohort studies from Europe and the United States, including a total of 17,286 participants, including 10,393 (60.
1%) women, with a mean (SD) baseline age of 74.
5 ( 7.
3) years old
.

The primary outcome was risk of dementia, risk of death, combined dementia and risk of death, and covariates included baseline antihypertensive medication use, sex, education level, body mass index, smoking status, diabetes mellitus, history of stroke, history of myocardial infarction, and polypharmacy
.

Using a Cox proportional hazards regression model and using natural splines to explore non-linear associations, the study found: ■ In terms of dementia risk overall, for older adults, higher SBP was associated with lower dementia risk
.

※Specifically subdivided into different age groups: (1) For the elderly aged 60-70, the risk of dementia was the lowest when the SBP level was 134mmHg (95%CI, 102-149mmHg; P=0.
03)
.

(2) For the elderly aged 70-95 years, when the SBP level is in the range of 155mmHg-166mmHg, the risk of dementia is the lowest
.

■ In terms of mortality risk, the study found that the "U" curve relationship between SBP and mortality risk in the elderly is very clear.
When the SBP is 160mmHg, the mortality risk is the lowest
.

■ The joint curve between systolic blood pressure and risk of dementia and death is similar to the curve between systolic blood pressure and risk of death
.

■ The relationship between diastolic blood pressure (DBP) and dementia risk was generally similar to the relationship between systolic blood pressure and dementia risk, although the differences between age groups were less pronounced
.

Based on the above findings, the researchers believe that future trials of tailored blood pressure management in the elderly population should take into account the life expectancy and health status of the subjects
.

The relationship between blood pressure and dementia in the elderly is a bit unexpected.
However, in the past year, there is actually one case in the research on blood pressure and dementia risk in the elderly~ Even asymptomatic, orthostatic hypotension increases the risk of dementia in the elderly! Orthostatic hypotension (OH) is a condition in which blood pressure drops significantly when standing quickly
.

Typical symptoms of OH include dizziness in standing position, narrow field of vision, amaurosis or even syncope, dull pain in the back of the shoulder and neck (in a coat hanger distribution), and patients may also have no obvious symptoms or only non-specific fatigue, tremors, nausea,
etc.

In July 2021, a study [3] published in Hypertension pointed out that even asymptomatic OH increases the risk of dementia in the elderly! Figure 2: Research published in Hypertension The study included 2532 participants without dementia, mean age 73.
1 years, 62.
6% female, and 24.
3% had OH at baseline (545 asymptomatic and 70 symptomatic; 434 Name mild OH, 181 severe OH)
.

During 12 years of follow-up, 322 (12.
7%) participants were diagnosed with dementia
.

The analysis found that OH was associated with an adjusted hazard ratio of 1.
40 (95% CI, 1.
10-1.
76) for dementia, 1.
15 (0.
94-1.
40) for OH and cognitive impairment without dementia (CIND), and 1.
15 (0.
94-1.
40) for OH and The hazard ratio for progression from CIND to dementia was 1.
54 (1.
05-2.
25)
.

That is, OH increased the risk of dementia by 40%, CIND by 15%, and CIND progression to dementia by 54%! Further analysis found that asymptomatic OH was associated with dementia and progression from CIND to dementia similar to overall OH, whereas symptomatic OH was only associated with progression from CIND to dementia
.

This means that even with asymptomatic OH, the risk of dementia in older adults increases! Tips: OH how to confirm? In a quiet room with constant temperature, blood pressure was measured 4 times in the left arm with a sphygmomanometer (the first and second blood pressure measurements were measured in a sitting position, and the blood pressure was measured after a 5-minute rest each time; the third blood pressure was measured in a supine position after a 5-minute rest.
; then ask the participant to stand and measure the 4th blood pressure after 1 minute of standing)
.

OH was defined as a ≥20 mmHg drop in SBP or a ≥10 mmHg drop in DBP from the 3rd to the 4th reading
.

Real hammer! Blood pressure management "lower is better" is not suitable for the elderly.
In fact, the elderly with higher hypertension corresponds to lower dementia risk and lower risk of death, and it is not "undocumented".
The "Guidelines for the Appropriate Range of Levels" [4] (hereinafter referred to as "Guidelines") stipulates the appropriate blood pressure range for the elderly over 80 years old
.

The "Guidelines" pointed out that most hypertension-related studies mainly focus on the relationship between SBP and adverse health outcomes, while less attention is paid to DBP.
The correlation between functional indicators such as cognitive function
.

Therefore, the "Guidelines" stated that the current "lower is better" model of blood pressure management is not suitable for the elderly
.

After synthesizing the existing research evidence, the "Guide" recommends that the appropriate range of SBP for the elderly (≥80 years old) in China is 110-150 mmHg, and the DBP is 70-90 mmHg
.

Summary ●●1.
To prevent dementia, the SBP level should be controlled at 134mmHg for the elderly aged 60-70 years; the SBP level should be controlled at 155mmHg-166mmHg for the elderly aged 70-95 years
.

2.
Even in asymptomatic OH, the risk of dementia in the elderly will increase, and vigilance is required
.

Reference: [1]The Association of Age at Diagnosis of Hypertension With Brain Structure and Incident Dementia in the UK Biobank, Hypertension (2021).
[2]Association of Systolic Blood Pressure With Dementia Risk and the Role of Age, U-Shaped Associations, and Mortality.
JAMA Intern Med.
December 13, 2021.
[3]From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic Hypotension.
Hypertension.
2021, Jul 6.
Epub ahead of print.
[4]Chinese Preventive Medicine Association .
Guidelines for the Appropriate Range of Blood Pressure Levels for the Elderly in China.
Chinese Journal of Disease Control, 2021, 25(3):249-256, 372.
Source of this article: Cardiovascular Channel of the Medical Community Zhang Li's "Heart Pursues Innovation - 2021 Annual Cardiovascular Inventory" [prediction] On January 22, 2022, "The "Heart" Pursues Innovation - 2021 Cardiovascular Annual Inventory" held by the "Medical Community" media The event is coming, and cardiovascular experts will take stock of the latest research and academic progress in 2021, covering 7 specialized fields such as hypertension, coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation
.

Exploring the breakthrough of "heart" and creating the fashion of "heart" will conclude the cardiovascular research at home and abroad in 2021, and look forward to a new chapter in cardiovascular research in 2022
.

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