Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk

Hypertension. 2015 Mar;65(3):651-61. doi: 10.1161/HYPERTENSIONAHA.114.04568. Epub 2015 Jan 12.


Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk.

Clinical trial registration url: Unique identifier: NCT 00153101.

Trial registration: NCT00153101.

Keywords: heart rate; hypertension; myocardial infarction; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Benzimidazoles / therapeutic use
  • Benzoates / therapeutic use
  • Blood Pressure / physiology*
  • Cardiovascular Diseases / epidemiology*
  • Cognition Disorders / epidemiology*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Heart Rate / physiology*
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Hypertension / physiopathology*
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Ramipril / therapeutic use
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Risk Factors
  • Telmisartan


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Benzimidazoles
  • Benzoates
  • Ramipril
  • Telmisartan

Associated data