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Cited by 88Dementia and Cognitive Impairment ResearchBlood Pressure and Hypertension StudiesAlzheimer's disease research and treatments

Blood Pressure Variability and Progression of Clinical Alzheimer Disease

Open access
de Heus, Rianne A.A., Olde Rikkert, Marcel G.M., Tully, Phillip J., Lawlor, Brian A., Claassen, Jurgen A.H.R., for the NILVAD Study Group·2019·Hypertension
DOI 10.1161/hypertensionaha.119.13664
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Abstract

Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer’s Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer’s Disease Assessment Scale–cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer’s Disease Assessment Scale–cognitive subscale compared with patients in the lowest quartile (systolic: β, 2.24 [95% CI, 0.11–4.38], P =0.040; diastolic: β, 2.54 [95% CI, 0.33–4.75] P =0.024). This association was still present after 1.5 years (systolic: β, 2.86 [95% CI, 0.35–5.36], P =0.026; diastolic: β, 3.30 [95% CI, 0.67–5.93], P =0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer’s Disease Assessment Scale–cognitive subscale (systolic: P =0.036) and Disability Assessment for Dementia (systolic: P =0.020; diastolic: P =0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017340.

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  • Higher blood pressure causes stiffening and remodeling of large arteries because of increased mechanical stress on arterial walls.

    “Higher blood pressure causes stiffening and remodeling of large arteries because of the increased mechanical stress placed on the arterial walls [89].”

    From Primary Cilia and Cardiovascular Risk Factors in Alzheimer's Disease (2025) · cites this paper as [89]

    The “Mechanisms Linking BPV and AD” section (page not available in our copy) says higher blood pressure variability increases mechanical stress on arterial walls, resulting in stiffening and remodeling of large arteries. The citing sentence instead attributes that mechanism to higher blood pressure itself, which is not what this passage says. (LLM, conf=0.88)

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Authors
de Heus, R. A. A., Olde Rikkert, M. G. M., Tully, P. J., Lawlor, B. A., Claassen, J. A. H. R., & for the NILVAD Study Group
Affiliations
  • From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
  • The University of Adelaide (AU)
  • Trinity College Dublin (IE)
  • Radboud University Nijmegen (NL)
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-11
Volume
74
Issue
5
Pages
1172-1180
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hypertensionaha.119.13664
OpenAlex
W2976647152
Cited by
88
References
68
Citations by year
2026: 1 · 2025: 8 · 2024: 22 · 2023: 10 · 2022: 13 · 2021: 17 · 2020: 15 · 2019: 2
FWCI
9.34
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • RUNE (Research UNE) (submittedVersion, public-domain)
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 › Physiology › Alzheimer's disease research and treatments
Keywords
blood pressure variability, Alzheimer's disease, cognitive decline, functional decline, visit-to-visit blood pressure variability, home blood pressure monitoring, nilvadipine, disease progression
MeSH terms
Mental Status and Dementia Tests, Aged, Alzheimer Disease, Antihypertensive Agents, Blood Pressure Determination, Cognition Disorders, Double-Blind Method, Female, Humans, Hypertension, Male, Middle Aged, Nifedipine, Prognosis, Severity of Illness Index, Multivariate Analysis, Confidence Intervals, Linear Models, Disease Progression, Risk Assessment

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