Tighter blood pressure control is not linked to cognitive decline among older adults and may instead be associated with preservation of cognitive function, according to a new analysis.
Further, the cognitive benefits of tighter control are even more pronounced among black patients.
American Heart Association
Dr. Hajjar and colleagues report that subjects whose systolic blood pressure (SBP) was maintained at 150 mm Hg or higher during the study period saw significantly greater cognitive decline over 10 years, compared with those treated to levels of 120 mm Hg or lower (JAMA Neurol. 2017 Aug 21; doi: 10.1001/jamaneurol.2017.1863). Furthermore, the investigators noted a differential decrease by blood pressure levels for both cognitive scoring systems, with the greatest decline seen in the group with SBP of 150 mm/Hg or higher and the lowest decrease in the group with 120 mm/Hg or lower (P less than .001 for both).
Black patients saw a greater difference, compared with white patients, between the higher and lower SBP levels in the decrease in cognition. Adjusted differences between the group with 150 mm Hg or higher and those with 120 mm Hg or lower were –0.05 in white patients and –0.08 in black patients for the 3MSE test (P = .03), and –0.07 in white patients and –0.13 in black patients for the DSST (P = .05).
“Almost all guidelines have recommended that target blood pressures be similar for black and white patients,” the investigators wrote in their analysis, adding that “future recommendations for the management of hypertension and cognitive outcomes need to take this racial disparity into consideration.”
The study was funded by the National Institutes on Health and National Institute on Aging. Dr. Hajjar and his colleagues disclosed no conflicts of interest.