Senior Moment?
Check Blood Pressure
By Denise Mann

Exaggerations in Blood Pressure Variability May Increase Risk of Cognitive Dysfunction

Those senior moments you experience from time to time may actually be a result of exaggerations in your blood pressure variability, according to new research presented Wednesday at the 21st Annual Scientific Meeting of the American Society of Hypertension (ASH 2006) in New York City.

In the new study of 101 Japanese people aged 80 or older, the greater the numeric differences in blood pressure readings during the day, the greater the risk of cognitive dysfunction.

Aging is known to increase the risk of blood pressure variability, but exactly how these variations affect cognitive function is not clear, researcher Kenichi Sakakura, MD, of the Public Kiwa Clinic in Kumano, Mie, Japan, tells WebMD.

Treating Variability Helps

"To prevent the progression of cognitive dysfunction, it may be important to treat large blood pressure variations in the elderly," says Sakakura. Admitting that treatment for such variation is "difficult," he suggests that long-acting blood pressure medication may play an important role. The effects of these medications tend to last longer, and thus may keep blood pressure under control throughout the day.

"Although clinicians may be reluctant to treat older patients aggressively, perhaps because of perceived lower benefits or possible increased risk of medication side effects, these findings show the potential value of interventions," he says.

In the study, blood pressure was measured via 24-hour ambulatory blood pressure monitoring. This allows for the measurement of blood pressure at different times throughout the 24-hour period and gives a more accurate idea of the variations that might occur in a typical day. The researchers assessed cognitive function with the Mini-Mental State Examination (MMSE), a standard measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language.

In the study, about 55% were classified as having cognitive dysfunction. The greater the blood pressure variability seen on the 24-hour monitoring, the greater the risk of cognitive dysfunction, the researchers report.

The link between untreated high blood pressure and cognitive decline is well known, says Frederic Vagnini, MD, the medical director of Heart, Diabetes & Weight Loss Centers of New York and author of several books including Overcoming Metabolic Syndrome. Vagnini did not attend the meeting.

"Intensive management with lifestyle changes and medication can make a difference in both blood pressure and cognitive function," he says. "I do not accept senior moments," he tells WebMD, referring to the informal term given to the momentary lapse in memory sometimes experienced by a senior citizen.

"If an older person starts having memory problems, it's a good idea to rule out high blood pressure as a possible cause," he says.

Calling the findings "incredibly important," Thomas D. Giles, MD, ASH president and a professor of medicine at Tulane University School of Medicine in New Orleans, tells WebMD that the brain has one of the most sensitive vascular systems (or system of blood vessels) in the body.

"The fact that certain surges in blood pressure affect these blood vessels is exactly in keeping with the hypothesis that we want the brain to receive the proper amount of blood flow at pressures that are not excessive," he tells WebMD.

Published May 17, 2006. Courtesy of Anthem Blue Cross and Blue Shield.

Reviewed By Ann Edmundson

SOURCES: Kenichi Sakakura, MD, Public Kiwa Clinic, Kumano, Mie, Japan. Frederic Vagnini, MD, medical director, Heart, Diabetes & Weight Loss Centers of New York; author, Overcoming Metabolic Syndrome. Sakakura, K. "The relationship between exaggerated blood pressure variability and cognitive dysfunction in the very elderly." Abstract No. 34

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