Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs
Open accessAbstract
IMPORTANCE: The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. OBJECTIVE: To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS: Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. MAIN OUTCOMES AND MEASURES: Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. RESULTS: We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. CONCLUSIONS AND RELEVANCE: Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.
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The prescription of polypharmacy, cardiovascular medications, and psychotropic and dopaminergic drugs increases the risk of syncope and falls.
“The prescription of polypharmacy, cardiovascular medications, and psychotropic (neuroleptics and antidepressants) and dopaminergic drugs also increases the risk of syncope and falls. 381-385”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [383]
The Adverse Clinical Events section (page unavailable) reports falls and syncope, but does not link either to prescriptions; it found no significant differences across blood-pressure tertiles. A search for polypharmacy, psychotropic and dopaminergic drugs, and medication-related fall or syncope risk found no passage supporting the claimed increase in risk. (LLM, conf=0.76)
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- Authors
- Mossello, E., Pieraccioli, M., Nesti, N., Bulgaresi, M., Lorenzi, C., Caleri, V., Tonon, E., Cavallini, M. C., Baroncini, C., Di Bari, M., Baldasseroni, S., Cantini, C., Biagini, C. A., Marchionni, N., & Ungar, A.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Division of Geriatric Medicine, Azienda Unità Sanitaria Locale 3, Pistoia, Italy
- Division of Geriatric Cardiology and Medicine, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2015-04-01
- Volume
- 175
- Issue
- 4
- Pages
- 578
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W1975409580
- Cited by
- 247
- References
- 43
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 10 · 2023: 27 · 2022: 10 · 2021: 20 · 2020: 29 · 2019: 29 · 2018: 28 · 2017: 22 · 2016: 33 · 2015: 16
- FWCI
- 26.76
- Type
- journal article
- Language
- en
- Open access
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Funders
- Fondazione Cassa di Risparmio di Pistoia e Pescia
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- hypotension, antihypertensive drugs, cognitive decline, dementia, mild cognitive impairment, elderly patients, ambulatory blood pressure monitoring, office blood pressure, blood pressure reduction, Mini-Mental State Examination, vascular comorbidities, memory clinics, prognostic factors, hypertension in the elderly, Alzheimer's disease
- MeSH terms
- Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Cognition, Dementia, Female, Follow-Up Studies, Humans, Hypertension, Hypotension, Italy, Male, Memory, Neuropsychological Tests, Severity of Illness Index, Cohort Studies, Sample Size, Disease Progression, Blood Pressure Monitoring, Ambulatory, Cognitive Dysfunction
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