BACKGROUND AND OBJECTIVES Hypertension is a well-established cardiovascular risk factor for cognitive function. As blood pressure fluctuates because of aging-related changes, we examined the association between visit-to-visit blood pressure variability (BPV) and cognition in older adults. METHODS This prospective observational cohort study included 4,770 individuals aged older than 65 years with repeated blood pressure assessment participating in the Chicago Health and Aging Project, a bi-racial population-based study lasting from 1993 to 2012. Blood pressure was measured by research staff every 3 years over 18 of follow-up. Systolic and diastolic BPV was calculated as the sum of the absolute difference in blood pressure between successive measurements, divided by the number (n - 1) of assessments. Cognition was assessed by standardized cognitive tests, and z-scores for the composite cognitive score were computed. Multivariable adjusted linear regression models were used to evaluate the association of systolic and diastolic BPV during the study period with cognition at the last visit. RESULTS Of 4,770 individuals, 2,998 (62.9%) were women, 3,146 (66.0%) were Black, and the mean (SD) age at baseline was 71.3 (5.3) years. The mean systolic BPV was 17.7 mm Hg in Black individuals and 16.0 mm Hg in White participants. Higher systolic and diastolic BPV was associated with lower cognitive scores at the end of follow-up. Compared with individuals in the first tertile of systolic BPV (lower BPV), participants with third tertile (higher BPV) had lower cognitive scores by 0.074 standardized units (β -0.074; 95% CI -0.131 to -0.018), corresponding to 1.8 years older in cognitive age. This relationship differed by race, being significant only in older Black adults. Black individuals in the third tertile of systolic BPV had lower cognitive scores by 0.115 standardized units (β -0.115; 95% CI -0.183 to -0.047) compared with those in the first tertile, corresponding to 2.8 years older in cognitive age. Similar findings were observed for diastolic BPV. DISCUSSION Elevated BPV, particularly in older Black adults, was associated with a lower cognitive score, suggesting routine assessment for blood pressure to identify and mitigate the adverse role of BPV in cognitive functioning in older adults.

中文翻译：

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18 年随访中黑人和白人老年人的血压变异性和认知：一项基于人群的队列研究。


背景和目标 高血压是公认的认知功能心血管危险因素。由于血压会因衰老相关变化而波动，我们检查了老年人就诊血压变异性 （BPV） 与认知之间的关联。方法 这项前瞻性观察队列研究包括 4,770 名年龄在 65 岁以上并重复评估血压的人，他们参与了芝加哥健康与老龄化项目，这是一项持续于 1993 年至 2012 年的基于人群的双种族研究。研究人员在 18 次随访中每 3 年测量一次血压。收缩压和舒张压 BPV 的计算方法是连续测量之间的血压绝对差之和除以评估次数 （n - 1）。通过标准化认知测试评估认知，并计算复合认知评分的 z 分数。采用多变量调整线性回归模型评估研究期间收缩压和舒张压 BPV 与末次就诊认知的相关性。结果 在 4,770 人中，女性 2,998 人 （62.9%），黑人 3,146 人 （66.0%），基线时的平均 （SD） 年龄为 71.3 （5.3） 岁。黑人个体的平均收缩压 BPV 为 17.7 毫米汞柱，白人参与者为 16.0 毫米汞柱。较高的收缩压和舒张压 BPV 与随访结束时较低的认知评分相关。与收缩压 BPV 第一三分位数（较低 BPV）的个体相比，第三三分位数（较高 BPV）的参与者认知评分低 0.074 个标准化单位 （β -0.074;95% CI -0.131 至 -0.018），对应于认知年龄大 1.8 岁。这种关系因种族而异，仅在老年黑人成年人中显着。 收缩压 BPV 第三三分位数的黑人个体的认知评分比第一三分位数低 0.115 个标准化单位 （β -0.115;95% CI -0.183 至 -0.047），对应于认知年龄大 2.8 岁。舒张期 BPV 也观察到类似的发现。讨论 BPV 升高，尤其是在老年黑人中，与较低的认知评分相关，表明常规评估血压以识别和减轻 BPV 对老年人认知功能的不利影响。