Nonlinear Relations of Blood Pressure to Cognitive Function: The Baltimore Longitudinal Study of Aging

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 45; no. 3; pp. 374 - 379
• Main Authors: Waldstein, Shari R, Giggey, Paul P, Thayer, Julian F, Zonderman, Alan B
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.03.2005; Hagerstown, MD Lippincott
• Subjects: Aged; Aging - psychology; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Cognition; Cross-Sectional Studies; Diastole; Education; Female; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Hypertension - psychology; Hypotension - physiopathology; Hypotension - psychology; Longitudinal Studies; Male; Medical sciences; Memory; Middle Aged; Nonlinear Dynamics; Prospective Studies; Systole; Vertebrates: cardiovascular system; Human; Chemotherapy; Senescence; Demography; Treatment; Tobacco smoking; Alcohol; Antihypertensive agent; Arterial pressure; Blood pressure; Monitoring
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.0000156744.44218.74

This investigation examined cross-sectional and longitudinal relations, both linear and nonlinear, of blood pressure (BP) and its interaction with demographic and lifestyle variables to a broad spectrum of cognitive functions. Eight hundred forty-seven participants (503 men and 344 women) from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and clinical assessment of BP on 1 to 7 occasions over 11 years. Mixed-effects regression models, adjusted for age, education, gender, alcohol consumption, smoking status, depression scores, and use of antihypertensive medications, revealed nonlinear relations of systolic BP with longitudinal change on tests of nonverbal memory and confrontation naming; cognitive decline was apparent among older (80 years) individuals with higher systolic BP. Cross-sectional findings, across testing sessions, indicated moderated U- and J-shaped relations between BP and cognitive function. Both high and low diastolic BP were associated with poorer performance on tests of executive function and confrontation naming among less-educated persons; with tests of perceptuo-motor speed and confrontation naming among nonmedicated (antihypertensives) individuals; and with executive function among older individuals. Cross-sectional linear relations included higher systolic BP and poorer nonverbal memory in nondrinkers, and higher diastolic BP and poorer working memory among less-educated individuals. Results indicate that cross-sectional and longitudinal relations of BP to cognitive function are predominantly nonlinear and moderated by age, education, and antihypertensive medications. Careful monitoring and treatment of both high and low BP levels may be critical to the preservation of cognitive function.