Low blood pressure and the risk of dementia in very old individuals

Background: The role of blood pressure (BP) as a risk factor for dementia is complex and may be age dependent. In very old individuals, low BP might increase risk for dementia, perhaps by reducing cerebral perfusion pressure. Methods: The association between BP and dementia was examined in the Bronx Aging Study, a prospective study of 488 community-dwelling elderly individuals over age 75, dementia-free at baseline (1980 to 1983) and followed at 12- to 18-month intervals. Subjects with baseline BP and with at least one follow-up visit were included (n = 406). Incident dementia was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (3rd rev. ed.). Results: Over 21 years (median 6.7 years), 122 subjects developed dementia (65 Alzheimer's disease [AD], 28 vascular dementia, 29 other dementias). Relative risk of dementia increased for each 10-mm Hg decrement in diastolic (hazard ratio [HR] 1.20, 95% CI 1.03 to 1.40) and mean arterial (HR 1.16, 95% CI 1.02 to 1.32) pressure, adjusted for age, sex, and education. Low diastolic BP significantly influenced risk of developing AD but not vascular dementia. Upon examination of groups defined by BP, mildly to moderately raised systolic BP (140 to 179 mm Hg) was associated with reduced risk for AD (HR vs normal systolic BP group 0.55, 95% CI 0.32 to 0.96), whereas low diastolic BP (≤70 mm Hg) was associated with increased risk of AD (HR vs normal diastolic BP group 1.91, 95% CI 1.05 to 3.48). Subjects with persistent low BP over 2 years had higher risk of developing dementia (HR 2.19, 95% CI 1.27 to 3.77). Conclusions: Low diastolic pressure is associated with higher risk of dementia in elderly individuals over age 75. Dementia risk was higher in subjects with persistently low BP.