Blood Pressure Variability Linked to Cognitive Decline in High-Risk Adults

METHODOLOGY

Researchers conducted a pooled individual-participant analysis including 11,104 participants from two randomized controlled trials: the SPRINT-MIND (n = 9361; hypertensive adults without diabetes) and ACCORD-MIND (n = 2809; adults with type 2 diabetes).
Participants had baseline and follow-up cognitive assessments using the Digit Symbol Coding Test (SPRINT-MIND) or Digit Symbol Substitution Test (ACCORD-MIND). Visit-to-visit systolic BP variability was calculated using SBP readings from the 3-month visit through the final cognitive assessment.
Systolic BP variability was quantified using variation independent of mean (VIM) as the primary metric, with SD, coefficient of variation, and average real variability as alternative metrics.
The primary outcome was the longitudinal change in global cognitive performance over time, quantified as the annual rate of change in standardized DSST/DSCT Z-score.
Median follow-up was 3.94 years; participants contributed a mean of 12.0 BP measurements over the study period.

Each 10% increment in systolic BP variation independent of mean was associated with an additional annual decline of 0.008 Z-score units (P = .003) after full adjustment including mean systolic BP.
Participants in the highest tertile of systolic BP variability exhibited a faster rate of cognitive decline compared with those in the lowest tertile (regression coefficient, β = −0.005 per year; P = .049).
Exploratory stratified analyses suggested the adverse association between BP variability and cognitive decline appeared more pronounced under intensive BP control (ACCORD-MIND β = −0.035 per year; 95% CI, −0.063 to −0.007; SPRINT-MIND β = −0.013 per year; 95% CI, −0.021 to −0.005), although the pooled three-way interaction did not reach statistical significance.
The spline curves demonstrated approximately linear dose-response relationships between all BP variability metrics and cognitive decline, with no evidence of nonlinearity (P for nonlinearity = .925 for VIM).

New horizons of cardiotherapy Since the introduction of the first implantable stimulator and defibrillator (ICD), cardiological science has advanced far. ICDs are highly effective, but their main disadvantage is the complications associated with the electrodes. To avoid the need for venous access and complications caused by transvenous electrodes, a fully subcutaneous ICD system (pc-ICD) was developed.

Integrated model of medical care for the treatment of ST-segment elevation myocardial infarction in China A new study involving 6817 patients with acute ST-segment elevation myocardial infarction has shown that every minute of life counts. Chinese scientists have tested an integrated aid model. This study assessed the impact of a comprehensive IMPST treatment strategy in China.

The relationship between low‑density lipoprotein cholesterol, the apolipoprotein B ratio, and sarcopenia The ratio of low‑density lipoprotein cholesterol to apolipoprotein B (LDL‑C/ApoB) (LDL-C/ApoB), which reflects the cholesterol content in an atherogenic lipoprotein particle, may serve as a new biomarker for the risk of sarcopenia. Scientists conducted a study based on data from the largest American representative survey (NHANES).

Blood Pressure Variability Linked to Cognitive Decline in High-Risk Adults Higher visit-to-visit systolic blood pressure variability was independently associated with faster cognitive decline in adults at elevated cardiovascular risk, regardless of mean blood pressure levels in a study.

General Anesthesia Ups Heart Failure Risk After Valve Surgery Transcatheter aortic valve replacement (TAVR) patients who received general anesthesia had a higher incidence of heart failure at 1 year than those who received nongeneral anesthesia.