scholarly journals Blood Pressure and Risks of Cognitive Impairment and Dementia

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 217-225 ◽  
Author(s):  
Ya-Nan Ou ◽  
Chen-Chen Tan ◽  
Xue-Ning Shen ◽  
Wei Xu ◽  
Xiao-He Hou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Dose Response ◽  
Meta Analysis ◽  
Cognitive Disorders ◽  
Late Life ◽  
Population Characteristics ◽  
Antihypertensive Medications ◽  
Dementia Risk ◽  
Increased Risk

Controversies persist regarding the association between blood pressure (BP) and the risks of cognitive impairment and dementia due to inconsistent definitions of BP exposure and varying population characteristics. Here, we searched PubMed and performed a meta-analysis of the influence of BP exposure on the risks of cognitive disorders in prospective studies. Dose-response analyses were performed to illustrate the existence of linear/nonlinear relationships. The credibility of each meta-analysis was evaluated according to the risk of bias, inconsistency, and imprecision. Of the 31 628 citations, 209 were included in our systematic review, among which 136 were eligible for the meta-analysis. Overall, stronger associations were found in midlife than late-life. Moderate-quality evidence indicated that midlife hypertension was related to a 1.19- to 1.55-fold excess risk of cognitive disorders. Dose-response analyses of 5 studies indicated that midlife systolic BP >130 mm Hg was associated with an increased risk of cognitive disorders. With regard to BP exposure in late-life, high systolic BP, low diastolic BP, excessive BP variability, and orthostatic hypotension were all associated with an increased dementia risk. Encouragingly, the use of antihypertensive medications exhibited a 21% reduction in dementia risk. The U-shaped dose-response curve indicated that the protective window of diastolic BP level was between 90 and 100 mm Hg for low risk of Alzheimer disease. The relationships between BP variables and cognitive disorders are age- and BP type-dependent. Antihypertensive medications were associated with a reduced risk of dementia. However, the optimal dose, duration, and type for preventing cognitive disorders warrant further investigation.

scholarly journals Effectiveness of technology-based interventions in detection, prevention, monitoring and treatment of patients at risk or diagnosed with mild cognitive impairment: protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045978
Author(s):  
Jordi Martínez-Soldevila ◽  
Roland Pastells-Peiró ◽  
Carolina Climent-Sanz ◽  
Gerard Piñol-Ripoll ◽  
Mariona Rocaspana-García ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Cognitive Disorders ◽  
Increased Risk ◽  
Patients At Risk ◽  
Review Protocol

IntroductionThe gradual changes over the decades in the longevity and ageing of European society as a whole can be directly related to the prolonged decline in the birth rate and increase in the life expectancy. According to the WHO, there is an increased risk of dementia or other cognitive disorders as the population ages, which have a major impact on public health. Mild cognitive impairment (MCI) is described as a greater than expected cognitive decline for an individual’s age and level of education, but that does not significantly interfere with activities of daily living. Patients with MCI exhibit a higher risk of dementia compared with others in the same age group, but without a cognitive decline, have impaired walking and a 50% greater risk of falling.The urban lifestyle and advent of smartphones, mobility and immediate access to all information via the internet, including health information, has led to a totally disruptive change in most general aspects.This systematic review protocol is aimed at evaluating the effectiveness of technology-based interventions in the detection, prevention, monitoring and treatment of patients at risk or diagnosed with MCI.Methods and analysisThis review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. The search will be performed on MEDLINE (PubMed), CENTRAL, CINAHL Plus, ISI Web of Science and Scopus databases from 2010 to 2020. Studies of interventions either randomised clinical trials or pre–post non-randomised quasi-experimental designs, published in English and Spanish will be included. Articles that provide relevant information on the use of technology and its effectiveness in interventions that assess improvements in early detection, prevention, follow-up and treatment of the patients at risk or diagnosed with MCI will be included.Ethics and disseminationEthics committee approval not required. The results will be disseminated in publications and congresses.

Blood Pressure and the Risk of Dementia: A Dose-Response Meta-Analysis of Prospective Studies

2019 ◽  
Vol 15 (4) ◽  
pp. 345-358 ◽  
Author(s):  
Zuo-Teng Wang ◽  
Wei Xu ◽  
Hui-Fu Wang ◽  
Lin Tan ◽  
Chen-Chen Tan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dose Response ◽  
Prospective Studies ◽  
Meta Analysis

scholarly journals Hypertension in the United States Fire Service

2021 ◽  
Vol 18 (10) ◽  
pp. 5432
Author(s):  
Saeed U. Khaja ◽  
Kevin C. Mathias ◽  
Emilie D. Bode ◽  
Donald F. Stewart ◽  
Kepra Jack ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Age Groups ◽  
Total Sample ◽  
The United States ◽  
Fire Service ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiac Events ◽  
Antihypertensive Medications ◽  
Increased Risk

Hypertension is a major risk factor for atherosclerotic cardiovascular disease and cardiac remodeling and is associated with an increased risk of sudden cardiac events, the leading cause of duty-related death in the fire service. We assessed systemic blood pressures and prevalence of hypertension among US firefighters by decade of life. Medical records of career firefighters (5063 males and 274 females) from four geographically diverse occupational health clinics were assessed. Hypertension was defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg, or taking antihypertensive medication. Results from the firefighter sample were compared to the US general population (2015–2016 and 2017–2018 National Health and Nutrition Examination Surveys). Among the total sample, 69% of firefighters met the criteria for hypertension and 17% were taking antihypertensive medications. Percentages of hypertensive male and female firefighters were 45% and 11% among 20–29 years old, respectively, and increased to 78% and 79% among 50–59 years old, respectively. Compared to the general population, male firefighters had a higher prevalence of hypertension (p < 0.05) across all age groups (11–16% higher). In order to improve firefighter health and protect against sudden incapacitation in this public safety occupational group, increased efforts are necessary to screen for and manage high blood pressure.

Blood Pressure, Hypertension and The Risk of Aortic Dissection Incidence and Mortality: results from the Japan-Specific Health Checkups Study, the UK Biobank Study and a Meta-analysis of Cohort Studies

Circulation ◽  
2021 ◽  
Author(s):  
Makoto Hibino ◽  
Yoichiro Otaki ◽  
Elsa Kobeissi ◽  
Han Pan ◽  
Hiromi Hibino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
Dose Response ◽  
Meta Analysis ◽  
Response Relationship ◽  
Uk Biobank ◽  
Dose Response Relationship ◽  
Fractional Polynomial ◽  
The Uk ◽  
Specific Health

Background: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies concerning this topic have been published. We investigated the association between hypertension/elevated BP and AD in two cohorts and conducted a meta-analysis of published prospective studies, including these two studies. Methods: We analyzed data from the Japan Specific Health Checkups (J-SHC) Study and UK Biobank, which prospectively followed 534,378 and 502,424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks (RRs) were calculated using random effects models. A potential nonlinear dose-response relationship between BP and AD was tested using fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. Results: In the J-SHC Study and UK Biobank, there were 84 and 182 ADs during 4- and 9-year follow-up, and the adjusted HRs of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI: 1.78-4.04) in hypertensive individuals, 1.33 (95% CI: 1.05-1.68) and 1.27 (95% CI: 1.11-1.48) per 20-mmHg increase in systolic BP (SBP), and 1.67 (95% CI: 1.40-2.00) and 1.66 (95% CI: 1.46-1.89) per 10-mmHg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary RRs were 3.07 (95% CI 2.15-4.38, I2=76.7%, n=7 studies, 2,818 ADs, 4,563,501 participants) for hypertension and 1.39 (95% CI: 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2=57.0%, n=3) per 20-mmHg increase in SBP and per 10-mmHg in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mmHg and DBP >75 mmHg. Conclusions: Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose-dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD.

Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies

Hypertension ◽  
2021 ◽  
Author(s):  
Pingping Jia ◽  
Helen W.Y. Lee ◽  
Joyce Y.C. Chan ◽  
Karen K.L. Yiu ◽  
Kelvin K.F. Tsoi
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Literature Searches ◽  
Meta Regression

High blood pressure (BP) is considered as an important risk factor for cognitive impairment and dementia. BP variability (BPV) may contribute to cognitive function decline or even dementia regardless of BP level. This study aims to investigate whether BPV is an independent predictor for cognitive impairment or dementia. Literature searches were performed in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science to May 2021. Longitudinal studies that assessed the risk of dementia or cognitive impairment with BPV as the predictor was included. Meta-analysis and meta-regression were performed to evaluate the effect of BPV on the risk of dementia or cognitive impairment. A total of 5919 papers were identified, and 16 longitudinal studies were included, which had >7 million participants and a median age from 50.9 to 79.9 years and a median follow-up of around 4 years. Thirteen studies reported visit-to-visit BPV and concluded that systolic BPV increases the risk of dementia with a pooled hazard ratio of 1.11 (95% CI, 1.05–1.17), and increases the risk of cognitive impairment with a pooled hazard ratio of 1.10 (95% CI, 1.06–1.15). Visit-to-visit diastolic BPV also increased the risk of dementia and cognitive decline. A meta-regression revealed a linear relationship between higher BPV and risks of dementia and cognitive impairment. Similar findings were observed in the studies with day-to-day BPV. This study suggests that long-term BPV is an independent risk factor for cognitive impairment or dementia, so an intervention plan for reducing BPV can be a target for early prevention of dementia.

scholarly journals Genetic Variation in Blood Pressure and Lifetime Risk of Peripheral Artery Disease: A Mendelian Randomization Study

2020 ◽  
Author(s):  
Michael G Levin ◽  
Derek Klarin ◽  
Venexia M Walker ◽  
Dipender Gill ◽  
Julie Lynch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Peripheral Artery Disease ◽  
Genetic Correlations ◽  
Channel Blockers ◽  
Peripheral Artery ◽  
Antihypertensive Medications ◽  
Increased Risk ◽  
Genes Encoding ◽  
Artery Disease

Aims: We aimed to estimate the effect of blood pressure and blood pressure lowering medications (via genetic proxies) on peripheral artery disease. Methods and Results: GWAS summary statistics were obtained for BP (International Consortium for Blood Pressure + UK Biobank GWAS; N = up to 757,601 individuals), peripheral artery disease (PAD; VA Million Veteran Program; N = 24,009 cases, 150,983 controls), and coronary artery disease (CAD; CARDIoGRAMplusC4D 1000 Genomes; N = 60,801 cases, 123,504 controls). Genetic correlations between systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and CAD and PAD were estimated using LD score regression. The strongest correlation was between SBP and CAD (rg = 0.36; p = 3.9 x 10-18). Causal effects were estimated by two-sample MR using a range of pleiotropy-robust methods. Increased SBP, DBP, and PP increased risk of both PAD (SBP OR 1.25 [1.19-1.31] per 10mmHg increase, p = 3 x 10-18; DBP OR 1.27 [1.17-1.39], p = 4 x 10-8; PP OR 1.51 [1.38-1.64], p = 1 x 10-20) and CAD (SBP OR 1.37 [1.29-1.45], p = 2 x 10-24; DBP OR 1.6 [1.45-1.76], p = 7 x 10-22; PP OR 1.56 [1.4-1.75], p = 1 x 10-15). The effects of SBP and DBP were greater for CAD than PAD (pdiff = 0.024 for SBP, pdiff = 4.9 x 10-4 for DBP). Increased liability to PAD increased PP (beta = 1.04 [0.62-1.45] mmHg per 1 unit increase in log-odds in liability to PAD, p = 1 x 10-6). MR was also used to estimate the effect of BP lowering through different classes of antihypertensive medications using genetic instruments containing BP-trait associated variants located within genes encoding protein targets of each medication. SBP lowering via calcium channel blocker-associated variants was protective of CAD (OR 0.38 per 10mmHg decrease in SBP; 95% CI 0.19-0.77; p = 0.007). Conclusions: Higher BP is likely to cause both PAD and CAD but may have a larger effect on CAD risk. BP-lowering through calcium-channel blockers (as proxied by genetic variants) decreased risk of CAD.

Abstract P190: Antihypertensive Monotherapy And Risk Of Depression Incidence

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Anwar Alnakhli ◽  
Richard Shaw ◽  
Daniel Smith ◽  
Sandosh Padmanabhan
Keyword(s):  
Dose Response ◽  
Enzyme Inhibitor ◽  
Previous History ◽  
Cox Proportional Hazards ◽  
Recent Theory ◽  
Defined Daily Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Antihypertensive Medications ◽  
Increased Risk

Background: Recent theory suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders, however, empirical evidence is inconsistent Objective: We aimed to assess the risk of depression incidence as indicated by first-ever prescription of antidepressant in patients newly exposed to antihypertensive monotherapy and whether there is a dose-response relationship. Method: This study enrolled 2406 new users of antihypertensive monotherapy aged between 18 and 80 years with no previous history of antidepressant prescriptions. The exposure period (EP) to antihypertensive medication was fixed at one year starting from the first date of antihypertensive prescription between Jan 2005 and Mar 2012 and extended up to 12 months. Follow-up commence after the EP until March 2013. To test for dose-response relationship the cumulative defined daily dose (cDDD) of antihypertensive during the EP were stratified into tertiles. Cox proportional hazards models were used to estimate hazard ratios (HR) for depression incidence. Results: Among the five major classes of antihypertensive medications, calcium channel blocker (CCB) had the highest risk of developing depression after adjusting for covariates (HR = 1.40 95%CI 1.11,1.78) compared to angiotensin-converting enzyme inhibitor (ACEI). Angiotensin-receptor blocker (ARB) treatment showed higher risk of depression incidence with tertile 2(HR= 1.46, 95%CI 0.88,2.44) and tertile 3 (HR= 1.75, 95%CI 1.03,2.97) compared to tertile 1 of cDDD. Conclusion: Our findings confirmed previous evidence suggesting that CCB is associated with increased risk of depression incidence compared to ACEI. Risk of developing depression is also linked to ARB, though it might be dose dependent.

scholarly journals Coffee Consumption and Risk of Dementia and Alzheimer’s Disease: A Dose-Response Meta-Analysis of Prospective Studies

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1501 ◽  
Author(s):  
Susanna Larsson ◽  
Nicola Orsini
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Relative Risk ◽  
Confidence Interval ◽  
Dose Response ◽  
Prospective Studies ◽  
Linear Trend ◽  
Meta Analysis ◽  
Coffee Consumption ◽  
Increased Risk

Coffee consumption is associated with a reduced risk of several diseases but uncertainty remains about the influence of coffee consumption on the risk of dementia. We performed a dose-response meta-analysis to summarize the prospective data on coffee consumption and associated risk of dementia and Alzheimer’s disease. We identified studies by searching PubMed (from January 1966) and Web of Science (from January 1945) through 4 October 2018 and by scrutinizing the reference lists of pertinent publications. Two researchers independently reviewed the literature. Results were combined using a restricted cubic spline random-effects dose-response meta-analysis based on a one-stage approach. Eight relevant prospective studies were identified. These studies included 7486 dementia cases diagnosed among 328,885 individuals during an average follow-up of 4.9–25 years. Meta-analysis of all eight studies indicated no statistically significant association between coffee consumption and the risk of dementia and no deviations from a linear trend (p = 0.08). The relative risk of dementia per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval (CI) 0.98–1.05; p = 0.37). Meta-analysis of five studies that focused on Alzheimer’s disease revealed no association between coffee consumption and Alzheimer’s disease and no deviations from a linear trend (p = 0.79). The relative risk of Alzheimer’s disease per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval 0.95–1.07; p = 0.80). These results do not support an association between coffee consumption and an increased risk of overall dementia or Alzheimer’s disease specifically, but further research on the association of coffee consumption with dementia risk is needed.

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