NEUROLOGY 2003;61:1667-1672
© 2003 American Academy of Neurology
Low blood pressure and the risk of dementia in very old individuals
J. Verghese, MD,
R. B. Lipton, MD,
C. B. Hall, PhD,
G. Kuslansky, PhD and
M. J. Katz, MPH
From the Einstein Aging Study (Drs. Verghese, Lipton, Hall, and Kuslansky, M.J. Katz) and Departments of Neurology (Drs. Verghese, Lipton, Hall, and Kuslansky, M.J. Katz)and Epidemiology and Population Health (Drs. Lipton and Hall), Albert Einstein College of Medicine, Bronx, NY.
Address correspondence and reprint requests to Dr. J. Verghese, Einstein Aging Study, Albert Einstein College of Medicine, 1165 Morris Park Ave., Rm. 338, Bronx, NY 10461; e-mail: jverghes{at}aecom.yu.edu
Background: The role of blood pressure (BP) as a risk factor for dementia is complex and may be age dependent. In very old individuals, low BP might increase risk for dementia, perhaps by reducing cerebral perfusion pressure.
Methods: The association between BP and dementia was examined in the Bronx Aging Study, a prospective study of 488 community-dwelling elderly individuals over age 75, dementia-free at baseline (1980 to 1983) and followed at 12- to 18-month intervals. Subjects with baseline BP and with at least one follow-up visit were included (n = 406). Incident dementia was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (3rd rev. ed.).
Results: Over 21 years (median 6.7 years), 122 subjects developed dementia (65 Alzheimer’s disease [AD], 28 vascular dementia, 29 other dementias). Relative risk of dementia increased for each 10-mm Hg decrement in diastolic (hazard ratio [HR] 1.20, 95% CI 1.03 to 1.40) and mean arterial (HR 1.16, 95% CI 1.02 to 1.32) pressure, adjusted for age, sex, and education. Low diastolic BP significantly influenced risk of developing AD but not vascular dementia. Upon examination of groups defined by BP, mildly to moderately raised systolic BP (140 to 179 mm Hg) was associated with reduced risk for AD (HR vs normal systolic BP group 0.55, 95% CI 0.32 to 0.96), whereas low diastolic BP ( 70 mm Hg) was associated with increased risk of AD (HR vs normal diastolic BP group 1.91, 95% CI 1.05 to 3.48). Subjects with persistent low BP over 2 years had higher risk of developing dementia (HR 2.19, 95% CI 1.27 to 3.77).
Conclusions: Low diastolic pressure is associated with higher risk of dementia in elderly individuals over age 75. Dementia risk was higher in subjects with persistently low BP.
Received March 23, 2003.
Accepted in final form September 8, 2003.
Presented in part at the 54th Annual Meeting of the American Academy of Neurology, April 16, 2002, Denver, CO.
This article has been cited by other articles:
|
|
|
|
 
C. Pierce, J. Pecen, and K. J. McLeod
Influence of Seated Rocking on Blood Pressure in the Elderly: A Pilot Clinical Study
Biol Res Nurs,
October 1, 2009;
11(2):
144 - 151.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. S. Knopman
Mediterranean Diet and Late-Life Cognitive Impairment: A Taste of Benefit
JAMA,
August 12, 2009;
302(6):
686 - 687.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. P. Kennelly, B. A. Lawlor, and R. A. Kenny
Review: Blood pressure and dementia -- a comprehensive review
Therapeutic Advances in Neurological Disorders,
July 1, 2009;
2(4):
241 - 260.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M.D.M. Haag, A. Hofman, P. J. Koudstaal, M. M.B. Breteler, and B. H.C. Stricker
Duration of antihypertensive drug use and risk of dementia: A prospective cohort study
Neurology,
May 19, 2009;
72(20):
1727 - 1734.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Hoffman, J. Schmeidler, G. T. Lesser, M. S. Beeri, D. P. Purohit, H. T. Grossman, and V. Haroutunian
Less Alzheimer disease neuropathology in medicated hypertensive than nonhypertensive persons
Neurology,
May 19, 2009;
72(20):
1720 - 1726.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Knopman
Hypertension and late-life dementia: A real link?
Neurology,
May 19, 2009;
72(20):
1716 - 1717.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Silverman, M. S. Beeri, J. Schmeidler, C. Rosendorff, G. Angelo, R. S. Mavris, H. T. Grossman, G. A. Elder, J. Carrion-Baralt, and R. West
C-reactive protein and memory function suggest antagonistic pleiotropy in very old nondemented subjects
Age Ageing,
March 1, 2009;
38(2):
237 - 241.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Coley, S. Andrieu, V. Gardette, S. Gillette-Guyonnet, C. Sanz, B. Vellas, and A. Grand
Dementia Prevention: Methodological Explanations for Inconsistent Results
Epidemiol. Rev.,
November 1, 2008;
30(1):
35 - 66.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Knecht, H. Wersching, H. Lohmann, M. Bruchmann, T. Duning, R. Dziewas, K. Berger, and E. B. Ringelstein
High-Normal Blood Pressure Is Associated With Poor Cognitive Performance
Hypertension,
March 1, 2008;
51(3):
663 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Andel, M. Crowe, N. L. Pedersen, L. Fratiglioni, B. Johansson, and M. Gatz
Physical Exercise at Midlife and Risk of Dementia Three Decades Later: A Population-Based Study of Swedish Twins
J Gerontol A Biol Sci Med Sci,
January 1, 2008;
63(1):
62 - 66.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Cummings, R. Doody, and C. Clark
Disease-modifying therapies for Alzheimer disease: Challenges to early intervention
Neurology,
October 16, 2007;
69(16):
1622 - 1634.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. van den Berg, G. J. Biessels, A. J.M de Craen, J. Gussekloo, and R.G.J. Westendorp
The metabolic syndrome is associated with decelerated cognitive decline in the oldest old
Neurology,
September 4, 2007;
69(10):
979 - 985.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L.C. Vogels, P. Scheltens, J. M. Schroeder-Tanka, and H. C. Weinstein
Cognitive impairment in heart failure: A systematic review of the literature
Eur J Heart Fail,
May 1, 2007;
9(5):
440 - 449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hildrum, A. Mykletun, E. Stordal, I. Bjelland, A. A Dahl, and J. Holmen
Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study
J Epidemiol Community Health,
January 1, 2007;
61(1):
53 - 58.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. C. Shah, R. S. Wilson, J. L. Bienias, Z. Arvanitakis, D. A. Evans, and D. A. Bennett
Blood Pressure and Lower Limb Function in Older Persons
J Gerontol A Biol Sci Med Sci,
August 1, 2006;
61(8):
839 - 843.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Kurth and G. Logroscino
Can We Escape Stroke and Alzheimer Disease?
Stroke,
February 1, 2006;
37(2):
279 - 280.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Zuccala, R. Bernabei, and J. Verghese
Low blood pressure and the risk of dementia in very old individuals
Neurology,
August 10, 2004;
63(3):
598 - 599.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Qiu, E. von Strauss, B. Winblad, and L. Fratiglioni
Decline in Blood Pressure Over Time and Risk of Dementia: A Longitudinal Study From the Kungsholmen Project
Stroke,
August 1, 2004;
35(8):
1810 - 1815.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
More Data, More Questions on Hypotension and Dementia Risk in the Elderly
Journal Watch Neurology,
April 9, 2004;
2004(409):
6 - 6.
[Full Text]
|
|
|
|
|
|
|
An Association Between Low BP and Alzheimer Disease?
Journal Watch Cardiology,
February 20, 2004;
2004(220):
6 - 6.
[Full Text]
|
|
|
|
|
|
|
An Association Between Low BP and Alzheimer Disease?
Journal Watch (General),
January 23, 2004;
2004(123):
3 - 3.
[Full Text]
|
|
|
Correspondence:
Read all Correspondence
- Low blood pressure and the risk of dementia in very old individuals
- Giuseppe Zuccala, et al.
- Neurology Online, 3 Feb 2004
[Full text]
- Reply to Zuccala et al
- Joe Verghese
- Neurology Online, 3 Feb 2004
[Full text]
|
