@article {Streit100, author = {Sven Streit and Rosalinde K.E. Poortvliet and Wendy P.J. den Elzen and Jeanet W. Blom and Jacobijn Gussekloo}, title = {Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension}, volume = {17}, number = {2}, pages = {100--107}, year = {2019}, doi = {10.1370/afm.2367}, publisher = {The Annals of Family Medicine}, abstract = {PURPOSE Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged >=75 years with or without complex health problems.METHODS We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty.RESULTS Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69\%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5\%) and with SBP \<130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP \>150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend \<.001), not in those without (P for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment.CONCLUSIONS Participants aged >=75 years undergoing antihypertensive treatment, with SBP >=130 mm Hg compared to \<130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.}, issn = {1544-1709}, URL = {https://www.annfammed.org/content/17/2/100}, eprint = {https://www.annfammed.org/content/17/2/100.full.pdf}, journal = {The Annals of Family Medicine} }