Fluctuations in blood pressure in older people is associated with an increased risk of dementia and cognitive decline, particularly in men, a study has found.

Professor Joanne Ryan

Researchers say it could provide the first evidence that blood pressure variability (BPV) could have sex-specific effects on cognition.

The new report from the ASPREE study, involving Monash University researchers, is published in the Journal of the American Heart Association.

Researchers say the findings could help identify people at increased risk of cognitive impairment and open the way to new areas of research.

Associate Professor Joanne Ryan from the Monash School of Public Health and Preventative Medicines says dementia will remain a major public health priority with the over-sixties set to outnumber adolescents by 2050.

“Any opportunity to identify early those at risk, and engage people in preventive therapies, is important,” she said.

Differences between men and women

Mid-life Hypertension has previously been associated with dementia in later life and it’s only recently that data has shown short and long-term fluctuations in blood pressure can also point to cognitive decline.

Previous BVP studies have involved younger people, focused on older people who already had cognitive decline, and used standardised blood pressure and cognition assessments.

The current research used data from 16,758 participants with long-term follow up, Professor Ryan says.

It also assessed depression and used a wide range of cognitive tests.

“Over time, differences emerged,” Professor Ryan said.

“Those in the highest BPV group were shown to be at significantly increased risk of dementia and cognitive decline compared to those in the lowest BPV group.

“Being male also increased the risk significantly.”

More research needed

The researchers say it’s unclear what the exact relationship between BVP and cognition is, although there’s increasing evidence the variable blood pressure is associated with structural changes in the brain.

There’s also speculation that the degeneration of neurons and synapses associated with Alzheimer’s disease might influence the way the body regulates blood pressure and this might contribute to BVP.

Professor Ryan suggests that hormones like oestrogen might help protect women from the effects suffered in men but says more investigation is needed.

“More study is warranted into this area to help determine the underlying reasons for these sex-specific differences,” she said.

The new paper is among the findings yielded from the ASPREE (ASPirin in Reducing Events in the Elderly) dataset.

The primary prevention aspirin trial released main results in 2018.

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