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Longitudinal and postural changes of blood pressure predict dementia : the Malmö Preventive Project

Holm, Hannes LU ; Nägga, Katarina LU ; Nilsson, Erik D. LU ; Melander, Olle LU ; Minthon, Lennart LU ; Bachus, Erasmus LU ; Fedorowski, Artur LU and Magnusson, Martin LU (2017) In European Journal of Epidemiology 32(4). p.327-336
Abstract

The role of blood pressure (BP) changes in dementia is debatable. We aimed to analyse how resting and postural BP changes relate to incident dementia over a long-term follow-up. In the prospective population-based Malmö Preventive Project, 18,240 study participants (mean age: 45 ± 7 years, 63% male) were examined between 1974 and 1992 with resting and standing BP measurement, and re-examined between 2002 and 2006 at mean age of 68 ± 6 years with resting BP. A total of 428 participants (2.3%) were diagnosed with dementia through Dec 31, 2009. The association of resting and postural BP changes with risk of dementia was studied using multivariable-adjusted Cox regression models controlling for traditional risk factors. Diastolic BP (DBP)... (More)

The role of blood pressure (BP) changes in dementia is debatable. We aimed to analyse how resting and postural BP changes relate to incident dementia over a long-term follow-up. In the prospective population-based Malmö Preventive Project, 18,240 study participants (mean age: 45 ± 7 years, 63% male) were examined between 1974 and 1992 with resting and standing BP measurement, and re-examined between 2002 and 2006 at mean age of 68 ± 6 years with resting BP. A total of 428 participants (2.3%) were diagnosed with dementia through Dec 31, 2009. The association of resting and postural BP changes with risk of dementia was studied using multivariable-adjusted Cox regression models controlling for traditional risk factors. Diastolic BP (DBP) decrease on standing indicated higher risk of dementia [Hazard ratio (HR) per 10 mmHg: 1.22; 95% confidence interval (CI) 1.01–1.44, p = 0.036], which was mainly driven by increased risk in normotensive individuals. Higher systolic (SBP) and diastolic BP at re-examination was associated with lower risk of dementia (HR per 10 mmHg: 0.94; 95% CI 0.89–0.99, p = 0.011; and 0.87; 0.78–0.96, p = 0.006, respectively). Extreme decrease in SBP/DBP between baseline and re-examination (4th quartile; −7 ± 12/−15 ± 7 mmHg, respectively) indicated higher risk of dementia (HR 1.46; 95% CI 1.11–1.93, p = 0.008, and 1.54; 95% CI 1.14–2.08, p = 0.005; respectively) compared with reference group characterised by pronounced BP increase over the same period (1st quartile; +44 ± 13/+15 ± 7 mmHg). Diastolic BP decrease on standing in the middle age, decline in BP between middle-and advanced age, and lower BP in advanced age are independent risk factors of developing dementia.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, Dementia, Orthostatic hypotension, Prospective studies, Risk factors
in
European Journal of Epidemiology
volume
32
issue
4
pages
327 - 336
publisher
Springer
external identifiers
  • scopus:85012134707
  • wos:000401854600008
ISSN
0393-2990
DOI
10.1007/s10654-017-0228-0
language
English
LU publication?
yes
id
b4954a0a-d2ec-4518-bc6b-d17d3e31522b
date added to LUP
2017-02-27 13:54:31
date last changed
2018-01-07 11:52:58
@article{b4954a0a-d2ec-4518-bc6b-d17d3e31522b,
  abstract     = {<p>The role of blood pressure (BP) changes in dementia is debatable. We aimed to analyse how resting and postural BP changes relate to incident dementia over a long-term follow-up. In the prospective population-based Malmö Preventive Project, 18,240 study participants (mean age: 45 ± 7 years, 63% male) were examined between 1974 and 1992 with resting and standing BP measurement, and re-examined between 2002 and 2006 at mean age of 68 ± 6 years with resting BP. A total of 428 participants (2.3%) were diagnosed with dementia through Dec 31, 2009. The association of resting and postural BP changes with risk of dementia was studied using multivariable-adjusted Cox regression models controlling for traditional risk factors. Diastolic BP (DBP) decrease on standing indicated higher risk of dementia [Hazard ratio (HR) per 10 mmHg: 1.22; 95% confidence interval (CI) 1.01–1.44, p = 0.036], which was mainly driven by increased risk in normotensive individuals. Higher systolic (SBP) and diastolic BP at re-examination was associated with lower risk of dementia (HR per 10 mmHg: 0.94; 95% CI 0.89–0.99, p = 0.011; and 0.87; 0.78–0.96, p = 0.006, respectively). Extreme decrease in SBP/DBP between baseline and re-examination (4th quartile; −7 ± 12/−15 ± 7 mmHg, respectively) indicated higher risk of dementia (HR 1.46; 95% CI 1.11–1.93, p = 0.008, and 1.54; 95% CI 1.14–2.08, p = 0.005; respectively) compared with reference group characterised by pronounced BP increase over the same period (1st quartile; +44 ± 13/+15 ± 7 mmHg). Diastolic BP decrease on standing in the middle age, decline in BP between middle-and advanced age, and lower BP in advanced age are independent risk factors of developing dementia.</p>},
  author       = {Holm, Hannes and Nägga, Katarina and Nilsson, Erik D. and Melander, Olle and Minthon, Lennart and Bachus, Erasmus and Fedorowski, Artur and Magnusson, Martin},
  issn         = {0393-2990},
  keyword      = {Blood pressure,Dementia,Orthostatic hypotension,Prospective studies,Risk factors},
  language     = {eng},
  month        = {02},
  number       = {4},
  pages        = {327--336},
  publisher    = {Springer},
  series       = {European Journal of Epidemiology},
  title        = {Longitudinal and postural changes of blood pressure predict dementia : the Malmö Preventive Project},
  url          = {http://dx.doi.org/10.1007/s10654-017-0228-0},
  volume       = {32},
  year         = {2017},
}