Higher BP Variability Linked to Cognitive Impairment in Elderly Heart Failure Patients, suggests study
Researchers have identified in a new study that increased day-to-day blood pressure variability (BPV) is independently related to cognitive impairment in older patients with acute decompensated heart failure (ADHF). This was most evident in patients with heart failure with preserved ejection fraction (HFpEF). The results highlight the importance of BPV monitoring in older HF patients, as changes in blood pressure could lead to cognitive impairment. The study was conducted by Michiaki N. and colleagues published in the American Journal of Hypertension.
Heart failure (HF) and cognitive impairment are often comorbid in the elderly, but the mechanisms by which these two conditions are related are not well understood. Previous research has indicated an association between BPV and cognitive dysfunction, but data on this relationship in HF patients have been sparse. This study sought to determine whether elevated BPV is associated with cognitive impairment in hospitalized elderly patients with ADHF, as measured by Mini-Mental State Examination (MMSE) scores.
245 elderly patients (mean age 82.9 ± 6.0 years, 49.4% male) admitted to the hospital with ADHF were enrolled in this study. Day-to-day in-hospital BPV was measured over seven days by researchers using several parameters including standard deviation (SD), coefficient of variation (CV), maximum BP, minimum BP, and delta BP (δ [maximum-minimum] BP). MMSE scores were used to measure cognitive function, and participants were categorized into quartiles according to their scores. Logistic regression analysis was performed to determine the association between BPV and cognitive impairment after controlling for confounding variables.
Key Findings
Patients in the lowest quartile of MMSE had significantly greater BPV parameters in diastolic blood pressure (DBP):
• SD: 8.2 mmHg vs. 6.2 mmHg vs. 6.7 mmHg (p<0.001)
• CV: 13.3% vs. 9.94% vs. 10.9% (p<0.001)
• δ BP: 22.8 mmHg vs. 17.5 mmHg vs. 18.6 mmHg (p<0.001)
Logistic regression analysis that was adjusted for confounders revealed that higher BPV in diastolic BP was strongly related to the lowest quartile of MMSE
• SD (OR: 1.23, p<0.01)
• CV (OR: 1.12, p<0.01)
• Maximum BP (OR: 1.13, p<0.001)
• δ BP (OR: 1.07, p<0.01)
Stratified analysis by HF phenotype indicated that the relationship between greater BPV and cognitive impairment was strongest among HFpEF patients.
The study authors concluded that cognitive impairment with day-to-day blood pressure variability is becoming more common in elderly patients with acute decompensated heart failure, especially among those with HFpEF. These observations highlight the need to monitor and control BPV as a possible measure to avoid cognitive impairment in this high-risk group.
Reference:
Nagai M, Dote K, Kato M, Oda N, Saleh Velez FG, Dasari T. Day-to-day blood pressure variability and cognitive function in the elderly with acute heart failure. Am J Hypertens. 2025 Mar 11:hpaf030. doi: 10.1093/ajh/hpaf030. Epub ahead of print. PMID: 40068944
