Cardiovascular
The Association of Systolic and Diastolic Blood Pressure with Progression from Mild Cognitive Impairment to Dementia Silvia Miramontes* Silvia Miramontes Erin L. Ferguson Hunter Mills Evan Phelps Boris Oskotsky Elena Tsoy Maria Glymour Marina Sirota
Introduction: Mild cognitive impairment (MCI) is considered a transitional stage between normal cognition and dementia. Blood pressure (BP) is an accepted dementia risk factor, but its association with progression from MCI to Alzheimer’s Disease and Related Dementias (ADRD) is uncertain.
Methods: For 8,026 UCSF patients diagnosed with MCI, we calculated median BP over the 5 years preceding diagnosis (M=18 measurements per person) from electronic health records. Cox proportional hazards models assessed the association of systolic and diastolic BP (linear and restricted cubic splines) with incident ADRD, stratified by sex and race/ethnicity.
Results: Participants (mean age=70.7) were 57% female, 54% White, 22% Asian, 8% Black or African American, 8% Latinx, and 8% Other. Higher systolic BP (SBP) was more strongly associated with ADRD risk (HR:1.10 per 10 mmHg; 95% CI:1.06-1.13) than diastolic BP (DBP) (HR:1.01 per 10 mmHg; 95% CI:0.95-1.07). In sex-specific models, higher SBP was linearly associated with elevated ADRD risk in females (HR:1.14 per 10 mmHg increase; 95% CI:1.09-1.20), but not males (HR:1.03; 95% CI:0.97-1.10). DBP was similarly associated with ADRD risk in females (HR:1.08 per 10 mmHg increase; 95% CI:0.99-1.20) but not males (HR:0.92; 95% CI:0.84-1.00). Interaction models showed weaker BP effects in males (SBP interaction HR:0.90, p=0.003; DBP interaction HR:0.864, p=0.016) compared to females. DBP was more strongly associated with ADRD risk in Asians than in Whites (DBP interaction HR:1.18, p=0.028), with no differences observed in other groups. Spline models suggested non-linear associations for both BP types, with higher ADRD risk at extreme BP levels, particularly in females (Fig).
Conclusion: SBP was associated with progression to ADRD in females but not males. Diastolic BP may play a stronger role in ADRD risk in Asians compared to Whites. BP may influence which patients develop ADRD, though the causal nature of these findings remains uncertain.
