Rollercoaster Blood Pressure
An Alzheimer Disease Risk Factor?
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Dementia is a major public health threat affecting >50 million people worldwide and growing at an alarming rate of 9.9 million new diagnoses each year.1 Despite the recently described reduction in incidence, the number of patients with dementia is estimated to triplicate by 2050 as a result of the aging of the world population and the lack of disease-modifying treatments.1 Recent evidence suggests that hypertension contributes significantly to the development and progression of the 2 most common types of dementia: Alzheimer disease (AD) and vascular cognitive impairment–dementia (VaD).2 However, it remained unclear whether it is the average blood pressure level or blood pressure variability (BPV) that is responsible for the cognitive decline. In this issue of Circulation, Oishi et al3 provide new data strengthening the case that BPV is a key driver of the association with subsequent dementia, an effect that may be particularly relevant to AD.
Although blood pressure is often viewed as 2 simple numeric values, systolic blood pressure (SBP) and diastolic blood pressure (DBP), it is now well established that both SBP and DBP have marked oscillations in the short term (24 hours), midterm (days/weeks), and long term (years).4 Historically, variability in blood pressure was viewed as an impediment for the accurate assessment of blood pressure recordings and as a phenomenon to be reconciled by improved monitoring; however, over the last 20 years, BPV has been recognized as an independent risk factor for cardiovascular disease.4 Recently, several longitudinal studies have reported that increased long-term BPV, independent of the average blood pressure level, is associated with a higher risk of cognitive impairment and dementia (Table). However, in most studies, BPV was assessed by mid- and long-term office measurements, which are subject to considerable bias, and the association …