Increased beat-to-beat blood pressure variability is associated with impaired cognitive function

Nur Fazidah Asmuje, Sumaiyah Mat, Choon-Hian Goh, Phyo Kyaw Myint, Maw Pin Tan* (Corresponding Author)

*Corresponding author for this work

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Emerging evidence has linked visit-to-visit, day-to-day and 24-hour ABPM blood pressure variability (BPV) with cognitive impairment. Few studies have, however, considered beat-to-beat BPV. This study, therefore, evaluated the relationship between beat-to-beat BPV and cognitive function among
community-dwellers aged 55 years and over.
Data was obtained from the Malaysian Elders Longitudinal Research (MELoR) study, which employed random stratified sampling from three parliamentary constituencies within the Klang Valley. Beat-tobeat blood pressure (BP) was recorded using non-invasive BP monitoring (TaskforceTM,CNSystems).
Low frequency (LF), high frequency (HF) and low-to-high frequency (LF:HF) ratio for BPV were derived using fast Fourier transformation. Cognition was evaluated using the Montreal Cognitive Assessment (MoCA) test, and categorized into normal aging, mild impairment and moderate-to-severe impairment.
Data from 1140 individuals, mean age (SD) 68.48 (7.23) years, were included. Individuals with moderate-to-severe impairment had higher HF-BPV for systolic (SBP) and diastolic (DBP) blood pressure compared to individuals within the normal aging group (OR(95%CI)=2.29(1.62-3.24)) and (OR(95%CI)=1.80(1.32-2.45)), while HF-SBPV (OR(95%CI)=1.41(1.03-1.93)) but not HF-DBPV
was significantly higher with mild impairment compared to normal aging after adjustments for potential confounders. Moderate-to-severe impairment was associated with significantly lower LF:HF-SBPV (OR(95%CI)=0.29(0.18-0.47)) and LF:HF-DBPV (OR(95%CI)=0.49(0.34-0.72)), while mild
impairment was associated with significantly lower LF:HF-SBPV (OR(95%CI)=0.52(0.34-0.80) but not LF:HF-DBPV (OR(95%CI)=0.81(0.57-1.17), compared to normal aging with similar adjustments.
Higher HF-BPV, which indicates parasympathetic activation, and lower LF:HF-BPV, which addresses sympathovagal balance, were observed among individuals with moderate-to-severe cognitive impairment. Future studies should determine whether BPV could be a physiological marker or modifiable risk factor for cognitive decline.
Original languageEnglish
Pages (from-to)998-1005
Number of pages8
JournalAmerican Journal of Hypertension
Issue number12
Early online date7 Oct 2022
Publication statusPublished - Dec 2022

Bibliographical note

We are grateful to Prof Dr Chin Ai Vyrn and Prof Dr Shahrul Bahyah Kamaruzzaman from Faculty of Medicine, University of Malaya for their help in MELoR study. Ageing and Age Associated Disorders Research Group for helping with patient recruitment and data collection.
The Malaysian Elders Longitudinal Research (MELoR) study is now part of the Transforming Cognitive Frailty into Later Life Self-Sufficiency (AGELESS) longitudinal cohort study, currently funded by the Ministry of Higher Education Long Term Research Grant Scheme (LRGS/1/2019/UM/01/1).


  • blood pressure variability
  • cognitive impairment
  • dementia
  • autonomic function


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