Individuals aged ≥75 years who are treated with antihypertensive medications and have a systolic blood pressure (SBP) of ≥130 mm Hg display less cognitive decline after 1 year compared with individuals with an SBP of <130 mm Hg, according to a study published in the Annals of Family Medicine.

The Integrated Systematic Care for Older Persons (ISCOPE) population-based prospective cohort study was used to obtain patient data over a 1-year follow-up period in Leiden, the Netherlands. Patients included in the analysis were ≥75 years old (mean age, 82.4 years) and were randomly assigned to either a functional geriatric care plan or usual care. A total of 1266 patients who had answered a screening questionnaire were included in the analysis. Researchers evaluated the change from baseline to 1 year in various outcomes scales, including the Mini-Mental State Examination (MMSE), Groningen Activity Restriction Scale (GARS), and EQ-5D-3L.

Of the approximately 84% of the cohort that underwent antihypertensive therapy, those with an SBP of <130 mm Hg had a crude cognitive decline of 0.90 points (95% CI, 0.43-1.36) on the MMSE during 1 year vs 0.14 points (95% CI, 0.21-0.49) in patients with an SBP of >150 mm Hg (P for trend =.013).

A similar trend was observed in patients without antihypertensive treatment; however, this trend was not statistically significant (1.75 points [95% CI, 0.80-2.70] for SBP <130 mm Hg vs 0.54 points [95% CI, 0.43-1.41] for SBP >150 mm Hg; P for trend =.08).

Compared with patients with <130 mm Hg, patients who received antihypertensive treatment showed significantly less cognitive decline on the MMSE after a 1-year period when SBP was 130-150 mm Hg (0.71 points [95% CI, 0.20-1.22]; P =.007) and >150 mm Hg (1.01 points [95% CI, 0.47-1.55]; P <.001; P for trend <.001).

No differences were observed across SBP strata or antihypertensive treatment for daily functioning and quality of life.

Researchers found the same association for participants with complex health problems (P for trend <.001), but the association was not found for participants without complex health problems (P for trend =.35).

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A limitation of the study, according to the researchers, included the lack of data for patients whose physicians were relying on incompatible electronic medical record.

“Our present findings suggest the importance of close blood pressure monitoring for patients undergoing antihypertensive treatment, to maintain optimal cognition especially in those with complex health problems, those for whom we observed the strongest effect,” concluded the researchers.

Reference

Streit S, Poortvliet RKE, Elzen WPJD, Blom JW, Gussekloo J. Systolic blood pressure and cognitive decline in older adults with hypertension. Ann Fam Med. 2019;17(2):100-107.