Blood pressure, pulse pressure, and antihypertensive treatment: Association with cognitive decline and dementia in elderly Mexican-Americans.

摘要

The association between blood pressure in late life and cognitive decline has not been conclusively established and few population-based studies have examined the relationship between pulse pressure in late life and cognitive decline. Longitudinal observational studies examining the relationship between antihypertensive treatment and development of dementia in the elderly have produced inconsistent results, and the assessment of the medications by class has been limited. The objective of this study was to assess the relationship between blood pressure and pulse pressure with decline in cognitive function, and to evaluate the association between uses of any antihypertensive treatment and specific class of agents with incidence of dementia/CIND (cognitively impaired not demented).;The Sacramento Area Latino Study of Aging (SALSA) was a prospective longitudinal cohort study in a population comprised of 1789 community-dwelling, non-institutionalized Mexican Americans (age>=60). Cognitive assessments using "Modified Mini-Mental State Examination" and "Spanish English Verbal Learning Test", and measurements of systolic and diastolic blood pressure were performed at baseline and each of the 6 annual follow-up visits. A multistage process was used for the evaluation of dementia and CIND. Clinical assessment and adjudication were performed to establish a dementia case using DMS-IV criteria. Antihypertensive medication use was directly inspected at each participant's home at baseline and each follow-up visit. Linear mixed models were used to assess respectively, the association between systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) and cognitive function over time. Cox proportional hazard models were applied to examine the association between use of antihypertensive treatment as well as each antihypertensive drug class and the risk of dementia/CIND.;Results of 6 years of follow-up data from this study demonstrated that higher SBP and PP was associated with longitudinal decline in cognitive function; untreated individuals with uncontrolled SBP or high PP were at highest risk of cognitive impairment. Higher DBP was associated with longitudinal improvement in cognitive function. Furthermore, any antihypertensive medication use was associated with lower incidence of dementia/CIND. In particular, use of diuretics, beta blockers and ACE Inhibitors was associated with a lower incidence of dementia/CIND.