BLOOD-PRESSURE AND PERFORMANCE ON THE MINI-MENTAL-STATE-EXAMINATION IN THE VERY OLD - CROSS-SECTIONAL AND LONGITUDINAL DATA FROM THE KUNGSHOLMEN PROJECT

The authors examined the association of blood pressure with cognitive function as assessed by the Mini-Mental State Examination (MMSE) in a community-based Swedish cohort of 1,736 people aged 75-101 years. Age, sex, education, antihypertensive medication use, heart disease, and s troke were considered as covariates. Multiple linear regression analys is indicated that both systolic and diastolic blood pressure, measured in 1987-1989, were positively and significantly related to baseline M MSE score; baseline systolic pressure was also positively and signific antly related to follow-up MMSE score, measured after an average perio d of 40.5 months among subjects who were not taking antihypertensive m edication at baseline. Furthermore, in the nontreated group, multiple logistic regression showed that individuals with a baseline systolic p ressure less than 130 mmHg had an odds ratio of 1.88 (p = 0.05) for fo llow-up cognitive impairment (MMSE score <24) compared with those whos e systolic pressure was 130-159 mmHg. An increased but not statistical ly significant risk of cognitive impairment was associated with high b lood pressure (systolic pressure greater than or equal to 180 mmHg or diastolic pressure greater than or equal to 95 mmHg) only in persons t aking antihypertensive medication at baseline. Subjects with systolic pressure of 160-179 mmHg tended to be at lower risk of cognitive impai rment. These results may support the view that a certain blood pressur e level, particularly a systolic pressure of at least 130 mmHg, is imp ortant to the maintenance of cognitive functioning in the very old. Th ey also suggest that severe hypertension that is not well controlled ( systolic pressure greater than or equal to 180 mmHg or diastolic press ure 95 mmHg) is still a threat to cognitive function in this age group . However, the use of blood pressure measurements made at a single vis it and the relatively short follow-up period should be considered when interpreting these results.