Swinging Blood Pressure Readings Linked to Faster Cognitive Decline in Trials

That is the finding of a study in Alzheimer's & Dementia, the journal of the Alzheimer's Association. It is an observational analysis of data from two randomised trials, SPRINT-MIND and ACCORD-MIND, pooled across 11,104 participants. It shows an association, not a cause.

Doctors usually look at average blood pressure. This study looked at something different: how much the top number (systolic pressure) varied between visits. The researchers used a measure called variation independent of the mean. It is built so that it does not simply track a person's average pressure.

Everyone included had a thinking test at the start and at least one more later. They also had at least three blood pressure readings taken from 3 months onward. The thinking test was the Digit Symbol Substitution or Coding Test, which measures processing speed. Participants match symbols to numbers against the clock. Scores were converted to standard units so the two trials could be combined.

Each 10% increase in variability was linked to faster yearly decline on the test (β = −0.008 per year; 95% confidence interval −0.014 to −0.003). This held after the authors adjusted for average systolic pressure. The yearly difference is small, and the test covers only one thinking skill.

The trials treated blood pressure differently. SPRINT-MIND enrolled people with high blood pressure but without diabetes. It compared a target below 120 mmHg (intensive) with one below 140 mmHg (standard). ACCORD-MIND enrolled people with type 2 diabetes. According to the authors, SPRINT-MIND found intensive lowering reduced the risk of cognitive impairment, while ACCORD-MIND found no significant cognitive benefit.

The link between variability and decline appeared in the intensive-treatment groups of both trials, but not in the standard-treatment groups. However, the test for a real difference between the groups was not statistically significant (p = 0.054). The authors call this pattern exploratory and say it needs confirmation in future studies.

The authors suggest variability might help explain why the two trials gave different cognitive results. That is their interpretation. This analysis cannot show that it is true, and it cannot show that swings in blood pressure cause the decline.

The result adds a different angle to our October 8 report on a gut bacteria compound linked to Alzheimer's risk. That was a separate study on a separate mechanism. Both suggest that risk to the ageing brain may come from more than one source.

The authors say future work should test whether treatments that reduce blood pressure variability can protect thinking, and whether variability should become a treatment target alongside average pressure.

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