High blood pressure and resilience to physical and cognitive decline in the oldest old: The leiden 85-plus study

Objectives To evaluate the association between various blood pressure (BP) measures at age 85 and future decline in physical and cognitive function the oldest old. Design Longitudinal study. Setting The population-based Leiden 85-plus Study. Participants Five hundred seventy-two 85-year-old community-dwelling individuals. Measurements BP was measured at age 85 during home visits. Activities of daily living (ADLs) and Mini-Mental State Examination (MMSE) were assessed at age 85 and annually thereafter up to age 90. On average, participants were followed for 3.2 years. Cross-sectional and longitudinal analyses were performed using linear regression models using systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as the determinants. All analyses were adjusted for sociodemographic and cardiovascular factors. Results At age 85, higher SBP and PP were associated with lower ADL disability scores (both P =.01). Similarly, higher SBP, DBP, and MAP were associated with higher MMSE scores (all P <.05). From age 85 onward, higher SBP (P <.001), MAP (P =.01), and PP (P =.003) at age 85 were associated with lower annual increases in ADL disability scores. Likewise, higher SBP (P =.03) and PP (P =.008) at age 85 were associated with lower annual declines in MMSE scores. Additional analyses showed that the association between high BP and lower annual decline in MMSE score was most pronounced in participants with high ADL disability. Conclusion In the oldest old, higher SBP and PP are associated with resilience to physical and cognitive decline, especially in individuals with pre-existing physical disability.