PT  - JOURNAL ARTICLE
AU  - Christopher E Clark
AU  - Daniel Thomas
AU  - David J Llewellyn
AU  - Luigi Ferrucci
AU  - Stefania Bandinelli
AU  - John L Campbell
TI  - Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study
AID  - 10.3399/bjgp20X709589
DP  - 2020 Jul 01
TA  - British Journal of General Practice
PG  - e472--e480
VI  - 70
IP  - 696
4099  - http://bjgp.org/content/70/696/e472.short
4100  - http://bjgp.org/content/70/696/e472.full
SO  - Br J Gen Pract2020 Jul 01; 70
AB  - Background Systolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiovascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline.Aim To examine associations of IAD with cognitive decline in a community population.Design and setting A prospective study of older Italian adults enrolled in the InCHIANTI study.Method Univariable and multivariable associations of IAD were explored with declines in mini mental state examination (MMSE) scores, Trail Making Test A and B scores, and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline.Results The rate of decline for MMSE scores in 1133 participants was greater with IAD ≥5 mmHg or ≥10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD, 95% confidence interval [CI] = 1.02 to 1.31). Substantial decline in MMSE score was seen with IAD ≥5 mmHg (OR 1.41, 95% CI = 1.03 to 1.93), and in the composite outcome with IAD ≥5 mmHg (OR 1.44, 95% CI = 1.10 to 1.89) or ≥10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multivariable adjustment, an IAD ≥ 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03).Conclusion An IAD ≥5 mmHg is associated with cognitive decline in a representative older population. Given that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.