Affiliations: [a]
Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| [b]
Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| [c]
Department of Internal Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| [d]
Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Amsterdam, The Netherlands
Correspondence:
[*]
Correspondence to: Tessa van Middelaar, MD, H2-235, Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 5663446; Fax: +31 20 5669374; E-mail: [email protected].
Abstract: Background:High visit-to-visit variability (VVV) in blood pressure (BP) is associated with cerebrovascular lesions on neuroimaging. Objective:Our primary objective was to investigate whether VVV is associated with incident all-cause dementia. As a secondary objective, we studied the association of VVV with cognitive decline and cardiovascular disease (CVD). Methods:We included community-dwelling people (age 70–78 year) from the ‘Prevention of Dementia by Intensive Vascular Care’ (preDIVA) trial with three to five 2-yearly BP measurements during 6–8 years follow-up. VVV was defined using coefficient of variation (CV; SD/mean×100). Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). Incident CVD was defined as myocardial infarction or stroke. We used a Cox proportional hazard regression and mixed-effects model adjusted for sociodemographic factors and cardiovascular risk factors. Results:In 2,305 participants (aged 74.2±2.5), mean systolic BP over all available visits was 150.1 mmHg (SD 13.6), yielding a CV of 9.0. After 6.4 years (SD 0.8) follow-up, 110 (4.8%) participants developed dementia and 140 (6.1%) CVD. Higher VVV was not associated with increased risk of dementia (hazard ratio [HR] 1.00 per point CV increase; 95% confidence interval [CI] 0.96–1.05), although the highest quartile of VVV was associated with stronger decline in MMSE (β –0.09, 95% CI –0.17 to –0.01). Higher VVV was associated with incident CVD (HR 1.07; 95% CI 1.04–1.11). Conclusion:In our study among older people, high VVV is not associated with incident all-cause dementia. It is associated with decline in MMSE and incident CVD.
