Blood Pressure Parameters and Risk of Cognitive Decline and Dementia in Type 2 Diabetes: Results From the ADVANCE Trial

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CIs suggest statistical significance for most associations

• Effect Size: OR per SD increase: SBP variability 1.11, DBP variability 1.11, baseline pulse pressure 1.19

• Primary Outcome: Composite cognitive decline/dementia occurred in 1,674 (17.5%) participants over mean 3.5 years

• Nnt Or Sensitivity: Risk increase of 11-19% per SD increase in BP variability parameters

• Confidence Interval: 95% CIs ranged from 1.00-1.25, with baseline PP showing strongest association (1.13-1.25)

Clinical Application

BP variability monitoring feasible in routine practice but requires multiple measurements over time Relevant to Australian diabetes care guidelines and PBS-subsidised BP monitoring. Aligns with RACGP diabetes management recommendations for cardiovascular risk assessment Adults with type 2 diabetes, particularly those with established cardiovascular risk factors

Abstract

BACKGROUND: Blood pressure (BP) variability and cumulative BP load are significantly associated with cardiovascular disease risk beyond mean systolic BP, but less is known regarding their associations with cognitive decline/dementia and whether these associations differ by cognitive function at baseline or by sex. The aims of this study were to determine associations of different BP parameters with cognitive decline/dementia in patients with type 2 diabetes and explore differences by mild cognitive impairment at baseline and sex. METHODS: Using data from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) study, BP parameters were calculated from an 18-month exposure window comprising measurements at 3, 4, 6, 12, and 18 months, after randomization. Logistic regression was used to estimate the odds ratio (OR) per SD higher and 95% CI for the associations of BP parameters with the composite outcome of cognitive decline (≥3 points from baseline on the Mini-Mental State Examination) or clinical diagnosis of dementia. RESULTS: Of the 11 140 ADVANCE participants, 9586 patients had 5 complete BP measurements within the 18-month exposure window. After a mean follow-up of 3.5 years, 1674 (17.5%) participants were diagnosed with cognitive decline and/or dementia. Overall, variability and baseline pulse pressure (PP), but not BP load, were associated with higher odds of cognitive decline/dementia (OR: variability in systolic BP, 1.11 [95% CI, 1.05-1.17]; diastolic BP, 1.11 [95% CI, 1.05-1.17]; PP, 1.05 [95% CI, 1.00-1.11]; mean arterial pressure, 1.13 [95% CI, 1.07-1.19]; and baseline PP, 1.19 [95% CI, 1.13-1.25]). There were no differences by mild cognitive impairment at baseline or sex. CONCLUSIONS: Higher BP variability and baseline PP, but not mean BP or BP load, were associated with higher odds of cognitive decline/dementia in patients with type 2 diabetes. BP variability and PP may be important therapeutic markers for the preservation of brain health. REGISTRATION: URL: https://clinicaltrials.gov; Unique Identifier: NCT00145925.

References

1. 1.ADVANCE Collaborative Group. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 358(24), 2560-2572. https://doi.org/10.1056/NEJMoa0802987