Márlon J R Aliberti1,2, Claudia Szlejf3, Maria Fernanda Lima-Costa4, Fabíola B de Andrade4, Tiago S Alexandre5, Cleusa P Ferri6, Claudia K Suemoto1. 1. Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. 2. Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil. 3. Department of Diagnostic and Ambulatory Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 4. Rene Rachou Research Institute, Oswaldo Cruz Foundation (FIOCRUZ), Minas Gerais, Brazil. 5. Department of Gerontology, Federal University of Sao Carlos, Sao Paulo, Brazil. 6. Department of Psychiatry, Universidade Federal de Sao Paulo, Brazil.
Abstract
BACKGROUND: The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years. METHOD: Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment. RESULTS: We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50-64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50-64 years (β = -0.09; 95% confidence interval = -0.15, -0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores. CONCLUSIONS: Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults.
BACKGROUND: The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years. METHOD:Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment. RESULTS: We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50-64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50-64 years (β = -0.09; 95% confidence interval = -0.15, -0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores. CONCLUSIONS:Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults.