Editors' note: Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology
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Using 3 prospective observational cohorts including 1,288 patients with available clinical and pathologic data, Arvanitakis et al. estimated the association between longitudinal blood pressure (BP) measures and the risk of histopathologic cerebral infarctions. The investigators observed that, for a patient whose mean systolic BP (SBP) was 1 SD above the cohort's mean SBP, that patient would be at a 46% increased risk of any cerebral infarction. This relationship accounted for age at time of death, sex, level of education, and years of study participation. Similar, but less robust, effects were observed in patients with higher diastolic BP (DBP) and those with a greater decline in BP at the end of life. Furthermore, higher SBP correlated with a higher number of neurofibrillary tangles. Drs. Lattanzi and Silvestrini suggest that pulse pressure and BP variability may also contribute to the risk of vascular and Alzheimer dementia. Arvanitakis et al. were able to apply their original methodology to this question and found that pulse pressure and SBP variability, but not DBP variability, were associated with cerebral infarct burden. However, using multivariable regression, they did not confirm that the variability of BP changes was independently associated with neurofibrillary tangles. The investigators conclude that higher SBP remains a driving force in the relationship between hypertension and vascular dementia, and that further investigation is needed to examine various BP measures and their relationship to dementia and its underlying neuropathology.
Using 3 prospective observational cohorts including 1,288 patients with available clinical and pathologic data, Arvanitakis et al. estimated the association between longitudinal blood pressure (BP) measures and the risk of histopathologic cerebral infarctions. The investigators observed that, for a patient whose mean systolic BP (SBP) was 1 SD above the cohort's mean SBP, that patient would be at a 46% increased risk of any cerebral infarction.
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