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Blood Pressure and Cognitive Impairment in Heart Failure Patients

Results from several studies have demonstrated an association between heart failure and cognitive impairment; brain hypoperfusion is one of several postulated mechanisms. To explore this association, Italian researchers studied 13,635 hospitalized elderly patients, of whom 1583 (mean age, 78) had heart failure. Just before discharge, blood pressure was measured, and cognition was assessed by standardized testing.

Cognitive impairment was found significantly more frequently among patients with heart failure than among those without heart failure (26% vs. 19%). In analyses adjusted for several confounding variables, cognitive dysfunction was associated with lower systolic BP among heart-failure patients: Systolic BP lower than 130 mm Hg was found in 46% of heart-failure patients with cognitive impairment and in 27% of those without impairment -- a significant difference. Among patients without heart failure, there was no correlation between BP and cognitive dysfunction.

Comment: These findings are intriguing; however, undoubtedly there are other confounding variables that were not accounted for in this study, and causal links between heart failure, cognition, and BP remain unclear. Because hypotensive drugs are a mainstay of heart-failure therapy, we will face a dilemma if additional research shows that active lowering of systolic BP to below 130 mm Hg increases risk for cognitive dysfunction among heart-failure patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 8, 2002

Citation(s):

Zuccalà G et al. Hypotension and cognitive impairment: Selective association in patients with heart failure. Neurology 2001 Dec 11; 57:1986-92.

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