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Treatment for high BP may slow cognitive decline in older patients
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The treatment of high BP may slow down the advancement of cognitive decline, according to research presented at the American Heart Association’s Hypertension Scientific Sessions.
In an observational study of Chinese individuals assessed for cognitive decline, patients receiving treatment for hypertension experienced a similar a rate of cognitive decline as those who did not have high BP at all, Shumin Rui, MS, a biostatistician at the Mailman School of Public Health at Columbia University, said during a presentation.
Furthermore, among patients with high BP aged 55 years or older, those who did not take treatment for hypertension presented with a more rapid decline in cognitive function compared with those who had received antihypertensive treatment.
“We think efforts should be made to expand high blood pressure screenings, especially for at-risk populations, because so many people are not aware that they have high blood pressure that should be treated,” Rui said in a press release. “This study focused on middle-aged and older adults in China, however, we believe our results could apply to populations elsewhere as well. We need to better understand how high blood pressure treatments may protect against cognitive decline and look at how high blood pressure and cognitive decline are occurring together.”
Using data from the CHARLS study collected between 2011-2015, researchers analyzed approximately 11,000 Chinese adults to determine how treatment for high BP (systolic BP, 140 mmHg; diastolic BP, 90 mmHg) could affect cognitive decline.
Researchers in the CHARLS study interviewed adults in China regarding BP treatment, education, rural or urban environment and also administered cognitive tests including memory quizzes.
A cognitive score was compiled from a composite of the Telephone Interview of Cognition Status score and a score based on immediate and delayed recall of 10 simple nouns.
The overall score declined from 11.01 in 2011 (standard deviation, 3.96) to 10.24 (standard deviation, 4.29) in 2015 (P < .01), according to the researchers.
Among those aged 55 years and older, patients with hypertension who were not aware of their condition had a larger decline in cognitive score by 0.57 points than those without hypertension (P < .01), but patients being treated for hypertension had a smaller decline by 0.56 points that patients unaware of their hypertension (P < .01), Rui and colleagues found.
The decline in score between patients without hypertension and patients treated for hypertension was similar in those aged 55 years and older (difference, –0.01; P = .96).
There were no differences in cognitive decline according to hypertension status in individuals aged 45 to 54 years, according to the researchers. – by Scott Buzby
Reference:
Rui S, et al. Presentation 004. Presented at: American Heart Association Hypertension Scientific Sessions; Sept. 5-8, 2019; New Orleans.
Disclosure: Rui reports no relevant financial disclosures.
Perspective
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Willie E. Lawrence Jr., MD, FAHA, FACC
This is an important study. It supports the observation that in the elderly, their awareness of whether they have hypertension and treatment of that hypertension can lead to slowing of their cognitive decline. There is increasing concern about the escalating rates of Alzheimer's and other brain diseases in elderly patients. This study highlights the important issue of brain health and the potential impact of hypertension management on it.
The CHARLS trial is an ambitious effort that began in 2011, tracking the social, economic and health circumstances of nearly 18,000 persons in China who were 45 years of age or older and their spouses. Patients over the age of 55 (elderly) who had hypertension, but were unaware of it, seemed to be at risk of greater cognition decline than the elderly without hypertension. In contrast, they observed that in elderly patients with hypertension, treatment of that hypertension may lead to a slowing of cognition decline to a level comparable to the decline among nonhypertensive patients. These same benefits were not evident in those younger than 45.
This is an important Chinese study with significant implications. It is important to see if similar observations are supported by studies of other populations of patients. It is valuable to see observations reproduced in other settings; making certain that there is not something specific about this particular Chinese population that may not be extended to observations in U.S. populations or other ethnicities.
The American College of Cardiology/AHA High Blood Pressure guidelines recommend a systolic BP treatment goal of less than 130 mm Hg for adults older than 65 years. The CHARLS observations illuminate the importance of getting this right. As we age, the prevalence of hypertension increases. As it relates to brain health, the benefits of BP lowering do not end as we age, but it is more likely that these benefits increase.
The researchers’ observations are very concise and very easy to conceptualize. It is an important message as we focus on the importance of managing hypertension in all populations. It is an important message as we think about brain health and how to preserve it.
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