Association of blood pressure variability during acute care hospitalization and incident dementia

Joseph E Ebinger; Matthew P Driver; Patrick Botting; Minhao Wang; Susan Cheng; Zaldy S Tan

doi:10.3389/fneur.2023.1085885

Association of blood pressure variability during acute care hospitalization and incident dementia

Front Neurol. 2023 Feb 7:14:1085885. doi: 10.3389/fneur.2023.1085885. eCollection 2023.

Authors

Joseph E Ebinger¹, Matthew P Driver¹, Patrick Botting¹, Minhao Wang¹, Susan Cheng¹, Zaldy S Tan^{2

3}

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
² Department of Neurology and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
³ David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.

Abstract

Background and objectives: Recognized as a potential risk factor for Alzheimer's disease and related dementias (ADRD), blood pressure variability (BPV) could be leveraged to facilitate identification of at-risk individuals at a population level. Granular BPV data are available during acute care hospitalization periods for potentially high-risk patients, but the incident ADRD risk association with BPV measured in this setting is unknown. Our objective was to evaluate the relation of BPV, measured during acute care hospitalization, and incidence of ADRD.

Methods: We retrospectively studied adults, without a prior ADRD diagnosis, who were admitted to a large quaternary care medical center in Southern California between January 1, 2013 and December 31, 2019. For all patients, determined BPV, calculated as variability independent of the mean (VIM), using blood pressure readings obtained as part of routine clinical care. We used multivariable Cox proportional hazards regression to examine the association between BP VIM during hospitalization and the development of incident dementia, determined by new ICD-9/10 coding or the new prescription of dementia medication, occurring at least 2 years after the index hospitalization.

Results: Of 81,892 adults hospitalized without a prior ADRD diagnosis, 2,442 (2.98%) went on to develop ADRD (2.6 to 5.2 years after hospitalization). In multivariable-adjusted Cox models, both systolic (HR 1.05, 95% CI 1.00-1.09) and diastolic (1.06, 1.02-1.10) VIM were associated with incident ADRD. In pre-specified stratified analyses, the VIM associations with incident ADRD were most pronounced in individuals over age 60 years and among those with renal disease or hypertension. Results were similar when repeated to include incident ADRD diagnoses made at least 1 or 3 years after index hospitalization.

Discussion: We found that measurements of BPV from acute care hospitalizations can be used to identify individuals at risk for developing a diagnosis of ADRD within approximately 5 years. Use of the readily accessible BPV measure may allow healthcare systems to risk stratify patients during periods of intense patient-provider interaction and, in turn, facilitate engagement in ADRD screening programs.

Keywords: blood pressure variability; dementia; hospitalization; hypertension; risk prediction.

Grants and funding

This work was supported in part by Cedars-Sinai Medical Center, the Erika J Glazer Family Foundation, and NIH grants R01-HL131532 and K23-HL153888. No funders had a role in the design/conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.