Decline in Blood Pressure over Time and Risk of Dementia : a population-based Longitudinal Study
Chengxuan Qiu, Eva von Strauss, Bengt Winblad, Laura Fratiglioni
Bok Svensk
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| Opplysninger | ABSTRACT: Background and Purpose- It is suspected that low blood pressure is correlated with the dementing process. We intended to verify blood pressure variations before and after dementia diagnosis and to examine the relationship between blood pressure decline and occurence of subsequent dementia and Alzheimer`s disease. Methods- A dementia-free cohort (n=947) aged >_75 years was longitudinally examined twice over 6 years to detct dementia cases (DSM-III-R diagnostic criteria). Blood pressure was measured at both baseline and follow-ups. Multiple Cox models were constructed to examine blood pressure decline from baseline to first follow-up in association with dementia detected at second follow-up. Results- Dementia was diagnosed in 186 subjects at first follow-up (147 with Alzheimer`s disease) and in 118 at secodn follow-up (91 with Alzheimer`s disease) Both systolic and diastolic pressure markedly decreased over 3 years before dementia diagnosis and continued to decline thereafter. Diastolic pressure decline was not significantly predictive of dementia. Compared with no decline, systolic pressure decline>_15mm Hg led to relative risks (95% confidence intervals) of 3.1 (1.3 to 7.0) for Alzheimer`s disease and 3.1 (1.5 to 6.3) for dementia among people with baseline systolic pressure <160 mm Hg, but no risk-effect was seen in those >_160 mm Hg. There was a dose-response relation between systolic pressure decline and dementia risk in individuals with vascular disease at baseline. Conclusions- Blood pressure markedly decrases in the preclinical phase of dementia and contiues to decline with dementia progression. A greater decline in systolic pressure is associated with dementia in selective subgroups of very old people.
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