Visit-to-Visit Blood Pressure Variability Is Associated With Cognitive Decline and Incident Dementia

To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS—Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=−0.12 (0.06), P =0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=−0.20 (0.06), P <0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD ( P =0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01–1.50], P =0.04). Similar results were found for diastolic BPV and mean arterial pressure variability ( P <0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

Factors of cardiovascular risk and intervisit arterial pressure variability

The aim: To determine the relationship between modified, unmodified cardiovascular risk factors (CRF) and intervisit arterial pressure variability (IAPW) in men of working age with arterial hypertension (AH).Material and methods. We examined 160 men with uncomplicated AH, among them, 82 patients had high IAPW, and 78 patients – low IAPW. The average age in patients with high and low IAPW did not differ and was 50.65 ± 6.14 and 50.26 ± 6.27 years, respectively (p = 0.689). Indices of IAPW were calculated based on the standard deviation (SD) of measurements of office blood pressure during 4 visits to the clinic. The criterion for high IAPW was the value of systolic arterial pressor (AP) – 15 / 15 mm Hg (day / night), for diastolic AP – 14/12 mm Hg (day / night). The analysis was carried out using standard statistical methods for parametric and non-parametric parameters. Results. It has been established, that the frequency of both modified and unmodified risk factors is greater in patients with hypertension and high IAPW, than in patients with low IAPW. The presence of obesity (36 of 82 versus 7 of 78; р ≤ 0.0001), family anamnesis (71 of 82 versus 52 of 78; p = 0.004), smoking episodes (62 of 82 versus 12 of 78; р ≤ 0.0001) and alcohol use (24 of 82 versus 2 of 78; p ≤ 0.0001) is significantly more common in patients with high IAPW, than in patients with low level of IAPW. There was a direct correlation between the MBA value and the percentage of 10-year risk of cardiovascular death on the SCORE scale (r = 0.47; p ≤ 0.0001) іn patients with hypertension.Conclusion. The results of the study confirm the hypothesis that, it is expedient to determine IAPW in patients with AH, as an independent prognostic risk factor for cardiovascular complications.

Pulse Photoplethysmographic Analysis Estimates the Sympathetic Activity Directed to Heart and Vessels

Background: Novel pulse photoplethysmographic–derived indices have been proposed as tools to measure autonomic nervous system (ANS) modulation in anesthetized and awake patients, but nowadays their experimental validation is lacking. The authors aimed to investigate the ability of pulse photoplethysmographic amplitude (PPGA), ANS state (ANSS), and ANSS index (ANSSi) to measure changes of ANS modulation in response to sympathetic stimulation. Methods: Ten awake healthy volunteers underwent two passive head-up tilts at 45° and 90°. The heart rate variability (HRV) and systolic arterial pressure variability were analyzed in the frequency domain as a measure of ANS modulation directed to the heart and the vessels. HRV, baroreflex sensitivity, and pulse photoplethysmographic indices were measured at baseline and after tilt maneuvers. The agreement between HRV-derived indices and pulse photoplethysmographic indices was assessed using Bland–Altman plots. Results: PPGA, ANSS, and ANSSi changed significantly during the study protocol. Head-up tilt decreased PPGA and ANSS and increased ANNSi. There was a good agreement between ANSSi and baroreflex sensitivity explored in the high-frequency band (bias, 0.23; 95% CI, −22.7 to 23.2 normalized units) and between ANSSi and the sympathovagal modulation directed to the heart (bias, 0.96; 95% CI, −8.7 to 10.8 normalized units). Conclusions: In controlled experimental conditions, novel pulse plethysmographic indices seem to estimate the changes of the sympathetic outflow directed to the vessels and the sympathovagal balance modulating heart rate. These indices might be useful in the future to monitor the fluctuation of sympathetic activity in anesthetized patients.