Elevated BP, as well as the presence of left ventricular hypertrophy (LVH) and total Framingham Stroke Risk Profile score, predict the development of clinically significant cognitive dysfunction, according to a study that examined vascular risk factors as they related to incident cognitive impairment in a national sample of adults aged 45 years and older.

The 23,752 subjects had no history of stroke or cognitive impairment at baseline and no evidence of stroke during the study. During a mean follow-up of 4.1 years, 1,907 participants met the criteria for incident cognitive impairment, which was significantly associated with their baseline Framingham score.

Among these subjects, age and LVH were the only score components that independently predicted cognitive decline. Each 10-year increment in age doubled the risk of cognitive impairment, and LVH, when adjusted for other factors, increased the risk by about 30%. When people with LVH were excluded from the model, elevated systolic BP was related to incident cognitive impairment, with each 10 mm Hg increase in systolic BP raising the risk of cognitive decline by 4%.

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The authors concluded that prevention and treatment of high BP may help preserve a person’s cognitive health (Neurology. 2011;77:1729-1736). A separate study takes that finding a step further, suggesting that people who want to stay physically and cognitively active talk to their clinicians about tracking ambulatory BP levels (Circulation. 2011;124:2312-2319).

This study involved a prospective cohort of persons aged 75 to 89 years. Data for the 72 patients who made it to the 24-month follow-up showed that increased ambulatory systolic BP — but not clinic systolic BP — was associated with increased white matter hyperintensity volume, which is a sign of small-vessel brain damage that has been linked with cognitive decline.