Supplemental Digital Content is available in the text. To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS—Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=−0.12 (0.06), P=0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=−0.20 (0.06), P<0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD (P=0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01–1.50], P=0.04). Similar results were found for diastolic BPV and mean arterial pressure variability (P<0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

中文翻译：

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访问访问血压变异性与认知衰退和痴呆症有关

补充数字内容在文本中可用。调查随访收缩压变异性 (BPV)、舒张压 BPV、平均动脉压变异性和脉压变异性对 65 岁以上非住院患者认知能力下降和痴呆事件的影响。来自 S.AGES (Sujets AGÉS-Aged Subjects) 队列的 3319 名受试者在 3 年内每 6 个月接受一次临床检查。使用标准偏差 (SD)、变异系数、平均实际变异、连续变异、独立于平均值的变异和残差 SD 来评估变异。使用简易精神状态检查和痴呆症与精神疾病诊断统计手册评估认知。使用了线性混合模型和 Cox 比例风险模型。较高的收缩压 BPV 与较差的认知相关，与基线 SBP 无关：调整后的 1-SD 变异系数增加：β (SE)=-0.12 (0.06)，P=0.04。对舒张压 BPV 和平均动脉压变异性观察到类似的结果：β (SE)=-0.20 (0.06)，两者的 P<0.001。调整年龄后，较高的脉压变异性不再与认知功能相关，除了残留的 SD（P=0.02）。在 3319 名受试者中，93 名 (2.8%) 患有痴呆症。较高的收缩压 BPV 与较高的痴呆风险相关（变异系数的调整后 1-SD 增加：风险比 = 1.23 [95% CI，1.01–1.50]，P = 0.04）。舒张压 BPV 和平均动脉压变异性的结果相似（P<0.01）。脉压变异性与痴呆风险无关。除了高血压，较高的 BPV 是认知障碍和痴呆的主要临床预测指标。需要进一步的研究来评估控制血压不稳定是否可以成为保护老年人认知的有希望的干预目标。