Blunted reduction in night-time blood pressure is associated with cognitive deterioration in subjects with long-standing hypertension

Objective: Data about the relationship of blunted reduction of night-time blood pressure (BP) with cognitive deterioration (CD) are conflicting. This study aims to explore this possible association in elderly people with long-standing hypertension. Methods: Twenty-six hypertensive subjects consecutively admitted to a rehabilitation unit over a six-month period were recruited. Exclusion criteria concerned all clinical conditions potentially related to BP variability or leading to CD. All patients underwent a clinic and 24-h BP non-invasive monitoring assessment of BP, as well as a cognitive assessment with the Mini Mental State Examination (MMSE). The presence of cerebrovascular disease (CVD) was assessed on CT films, with a standardized visual rating scale. Results: Blunted reduction of both systolic and diastolic night-time BP were significantly associated with poorer cognitive performances (r = 0.61, p = 0.001 for systolic; and r = 0.57, p = 0.002 for diastolic, respectively). In a multiple regression model, blunted reduction of night-time BP (B = 0.17, [95% confidence intervals: 1.1-1.3], p = 0.008 for systolic; and B = 0.15, [95% confidence intervals: 1.0-1.3], p = 0.02 for diastolic) independently predicted poorer cognitive performances. Conclusions: In subjects with long-standing hypertension the blunted reduction of night-time BP is independently associated with lower cognitive performances.