Baroreflex Sensitivity May Predict Dementia Risk in Seniors

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Baroreflex Sensitivity May Predict Dementia Risk in Seniors

TOPLINE:

Impairment in cardiac baroreflex sensitivity, which helps regulate blood pressure, is associated with an increased risk for dementia and mortality in older adults not taking antihypertensive medications.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess the association between cardiac baroreflex sensitivity and the risk for dementia and death in 1819 older adults (women, 62.6%; mean age, 71 years).
• Baroreflex sensitivity was determined from 5-minute beat-to-beat blood pressure recordings at supine rest; it measured the correlation between changes in systolic blood pressure and subsequent heartbeat interval responses, with higher values indicating superior baroreflex sensitivity.
• The median follow-up duration in the study was 14.8 years.
• The use of antihypertensive medications was reported by 32% of participants.
• The primary outcome was incident all-cause dementia, and the secondary outcome was all-cause mortality.

TAKEAWAY:

• Overall, 421 participants developed dementia in the study, with 324 being diagnosed with Alzheimer’s disease.
• The association between reduced baroreflex sensitivity and an increased risk for dementia varied significantly with respect to the use of antihypertensive medications (P for interaction = .03) and was significant only in participants not taking antihypertensive medication (adjusted hazard ratio [aHR], 1.60; P for trend = .02).
• Reduced baroreflex sensitivity also was associated with an increased risk for all-cause mortality in those not taking antihypertensive medication (aHR, 1.76; P for trend < .001).
• The association between baroreflex sensitivity and risk for dementia remained significant after adjusting for systolic blood pressure, variability in beat-to-beat systolic blood pressure, and arterial stiffness.

IN PRACTICE:

Baroflex sensitivity “may serve as a novel biomarker and potential therapeutic target for the early detection and prevention of dementia in older adults,” the authors of the study wrote. Monitoring baroreceptor function, which declines with age, “could be of particular clinical relevance in older adults,” they added.

SOURCE:

The study was led by Yuan Ma of the Department of Epidemiology at the Harvard T.H. Chan School of Public Health in Boston. It was published online on December 13, 2024, in Hypertension.

LIMITATIONS:

Cardiac baroreflex sensitivity was measured only during supine rest, which possibly did not fully reflect its impairment during routine activities and may have resulted in the underestimation of its true association with the risk for dementia. The assessment of baroreflex sensitivity only at baseline prevented the evaluation of its changes over time. The association between baroreflex sensitivity and dementia was observed only in participants not taking antihypertensive medication, making the results exploratory and requiring further replication. Owing to the predominance of White older participants in the study population, the generalizability of the findings to other populations is limited.