{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:05:31Z","timestamp":1759935931573},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2015,7,8]],"date-time":"2015-07-08T00:00:00Z","timestamp":1436313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (\u22120.15; \u22120.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The association between BP variability and cognitive impairment was not mediated by BPLM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpv101","type":"journal-article","created":{"date-parts":[[2015,7,9]],"date-time":"2015-07-09T01:04:58Z","timestamp":1436403898000},"page":"311-318","source":"Crossref","is-referenced-by-count":18,"title":["Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure\n                    Variability, and Cognitive Function in Old Age"],"prefix":"10.1093","volume":"29","author":[{"given":"Liselotte W.","family":"Wijsman","sequence":"first","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton J.M.","family":"de Craen","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majon","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Behnam","family":"Sabayan","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"},{"name":"Department of Radiology, Leiden University Medical Center 2 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Stott","sequence":"additional","affiliation":[{"name":"Academic Section of Geriatrics, Faculty of Medicine, University of Glasgow 3 , Glasgow , UK ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Ford","sequence":"additional","affiliation":[{"name":"Robertson Center for Biostatistics, University of Glasgow 4 , Glasgow , UK ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Trompet","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"},{"name":"Department of Cardiology, Leiden University Medical Center 5 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Wouter","family":"Jukema","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center 5 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudi G.J.","family":"Westendorp","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"},{"name":"Leyden Academy on Vitality and Ageing 6 , Leiden , The Netherlands ;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon P.","family":"Mooijaart","sequence":"additional","affiliation":[{"name":"Department of Gerontology and Geriatrics, Leiden University Medical Center 1 , Leiden , The Netherlands ;"},{"name":"Institute for Evidence-Based Medicine in Old age 7 , Leiden , The Netherlands ."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2015,7,8]]},"reference":[{"key":"2024012721430014500_CIT0001","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1053\/j.ajkd.2008.04.032","article-title":"Association between long-term blood pressure\n                        variability and mortality among incident hemodialysis\n                        patients","volume":"52","author":"Brunelli","year":"2008","journal-title":"Am J Kidney Dis"},{"key":"2024012721430014500_CIT0002","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1291\/hypres.23.553","article-title":"Office blood pressure variability as a predictor\n                        of brain infarction in elderly hypertensive patients","volume":"23","author":"Hata","year":"2000","journal-title":"Hypertens Res"},{"key":"2024012721430014500_CIT0003","doi-asserted-by":"crossref","first-page":"e52438","DOI":"10.1371\/journal.pone.0052438","article-title":"Blood pressure variability and cardiovascular\n                        risk in the PROspective Study of Pravastatin in the Elderly at Risk\n                        (PROSPER)","volume":"7","author":"Poortvliet","year":"2012","journal-title":"PLoS One"},{"key":"2024012721430014500_CIT0004","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/S1474-4422(10)70066-1","article-title":"Effects of beta blockers and calcium-channel\n                        blockers on within-individual variability in blood pressure and risk of\n                        stroke","volume":"9","author":"Rothwell","year":"2010","journal-title":"Lancet Neurol"},{"key":"2024012721430014500_CIT0005","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0140-6736(10)60308-X","article-title":"Prognostic significance of visit-to-visit\n                        variability, maximum systolic blood pressure, and episodic\n                        hypertension","volume":"375","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"2024012721430014500_CIT0006","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1001\/archneurol.2010.70","article-title":"Long-term blood pressure fluctuation and\n                        cerebrovascular disease in an elderly cohort","volume":"67","author":"Brickman","year":"2010","journal-title":"Arch\n                        Neurol"},{"key":"2024012721430014500_CIT0007","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/08037050500364117","article-title":"Blood pressure variability and white matter\n                        hyperintensities in older adults with cardiovascular\n                    disease","volume":"14","author":"Gunstad","year":"2005","journal-title":"Blood Press"},{"key":"2024012721430014500_CIT0008","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1161\/hs0102.101890","article-title":"Variability in midlife systolic blood pressure\n                        is related to late-life brain white matter lesions: the Honolulu-Asia Aging\n                        study","volume":"33","author":"Havlik","year":"2002","journal-title":"Stroke"},{"key":"2024012721430014500_CIT0009","doi-asserted-by":"crossref","first-page":"f4600","DOI":"10.1136\/bmj.f4600","article-title":"Association of visit-to-visit variability in\n                        blood pressure with cognitive function in old age: prospective cohort\n                        study","volume":"347","author":"Sabayan","year":"2013","journal-title":"BMJ"},{"key":"2024012721430014500_CIT0010","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1111\/jgs.12542","article-title":"Cognitive dysfunction and greater visit-to-visit\n                        systolic blood pressure variability","volume":"61","author":"Epstein","year":"2013","journal-title":"J Am Geriatr\n                        Soc"},{"key":"2024012721430014500_CIT0011","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.atherosclerosis.2013.11.071","article-title":"Visit-to-visit blood pressure variability in the\n                        elderly: associations with cognitive impairment and carotid artery\n                        remodeling","volume":"233","author":"Nagai","year":"2014","journal-title":"Atherosclerosis"},{"key":"2024012721430014500_CIT0012","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0140-6736(10)60235-8","article-title":"Effects of antihypertensive-drug class on\n                        interindividual variation in blood pressure and risk of stroke: a systematic\n                        review and meta-analysis","volume":"375","author":"Webb","year":"2010","journal-title":"Lancet"},{"key":"2024012721430014500_CIT0013","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0140-6736(98)03086-4","article-title":"Prevention of dementia in randomised\n                        double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur)\n                        trial","volume":"352","author":"Forette","year":"1998","journal-title":"Lancet"},{"key":"2024012721430014500_CIT0014","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1212\/WNL.0b013e3182a35228","article-title":"Antihypertensive drugs decrease risk of\n                        Alzheimer disease: Ginkgo Evaluation of Memory Study","volume":"81","author":"Yasar","year":"2013","journal-title":"Neurology"},{"key":"2024012721430014500_CIT0015","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.neurobiolaging.2006.10.006","article-title":"Use of calcium antagonists and cognitive decline\n                        in old age. The Leiden 85-plus study","volume":"29","author":"Trompet","year":"2008","journal-title":"Neurobiol\n                        Aging"},{"key":"2024012721430014500_CIT0016","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.mehy.2012.12.010","article-title":"Pharmacological blood pressure lowering in the\n                        older hypertensive patients may lead to cognitive impairment by altering\n                        neurovascular coupling","volume":"80","author":"Alrawi","year":"2013","journal-title":"Med Hypotheses"},{"key":"2024012721430014500_CIT0017","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/S0002-9149(99)00533-0","article-title":"The design of a prospective study of Pravastatin\n                        in the Elderly at Risk (PROSPER). PROSPER Study Group. PROspective Study of\n                        Pravastatin in the Elderly at Risk","volume":"84","author":"Shepherd","year":"1999","journal-title":"Am J\n                        Cardiol"},{"key":"2024012721430014500_CIT0018","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1136\/jnnp.73.4.385","article-title":"Testing cognitive function in elderly\n                        populations: the PROSPER study. PROspective Study of Pravastatin in the\n                        Elderly at Risk","volume":"73","author":"Houx","year":"2002","journal-title":"J Neurol Neurosurg\n                        Psychiatry"},{"key":"2024012721430014500_CIT0019","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in\n                        social psychological research: conceptual, strategic, and statistical\n                        considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"2024012721430014500_CIT0020","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/01.hco.0000240587.14463.58","article-title":"Treatment of hypertension based on measurement\n                        of blood pressure variability: lessons from animal studies","volume":"21","author":"Su","year":"2006","journal-title":"Curr Opin Cardiol"},{"key":"2024012721430014500_CIT0021","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/FJC.0b013e31803104e5","article-title":"Add-on amlodipine improves arterial function and\n                        structure in hypertensive patients treated with an angiotensin receptor\n                        blocker","volume":"49","author":"Ichihara","year":"2007","journal-title":"J Cardiovasc Pharmacol"},{"key":"2024012721430014500_CIT0022","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1161\/01.HYP.0000152701.97426.5f","article-title":"Thiazide-like diuretics attenuate\n                        agonist-induced vasoconstriction by calcium desensitization linked to Rho\n                        kinase","volume":"45","author":"Zhu","year":"2005","journal-title":"Hypertension"},{"key":"2024012721430014500_CIT0023","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/00045391-200205000-00005","article-title":"Confounding by indication in epidemiologic\n                        studies of commonly used analgesics","volume":"9","author":"Signorello","year":"2002","journal-title":"Am J\n                        Ther"},{"key":"2024012721430014500_CIT0024","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/ajh\/hpu181","article-title":"Biological correlates of blood pressure\n                        variability in elderly at high risk of cardiovascular\n                        disease","volume":"28","author":"Poortvliet","year":"2014","journal-title":"Am J Hypertens"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/article\/29\/3\/311\/2283822","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article\/29\/3\/311\/2283822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T21:44:04Z","timestamp":1706391844000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/29\/3\/311\/2283822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,8]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,7,8]]},"published-print":{"date-parts":[[2016,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpv101","relation":{},"ISSN":["1941-7225","0895-7061"],"issn-type":[{"value":"1941-7225","type":"electronic"},{"value":"0895-7061","type":"print"}],"subject":[],"published-other":{"date-parts":[[2016,3]]},"published":{"date-parts":[[2015,7,8]]}}}