Blood pressure, brain lesions and cognitive decline in patients with atrial fibrillation

TL;DR

This study found no strong link between blood pressure and brain lesions or cognitive decline in patients with atrial fibrillation over several years.

Contribution

The study provides new evidence on the lack of association between blood pressure and brain lesion development or cognitive decline in atrial fibrillation patients.

Findings

Blood pressure was not associated with new brain lesions in atrial fibrillation patients after 2 years.

No consistent link was found between blood pressure and cognitive decline over 6 years of follow-up.

Higher blood pressure was inversely linked to cognitive decline in one specific test, but not others.

Abstract

The influence of atrial fibrillation (AF) and blood pressure (BP) on brain lesions and cognitive function is unclear. We aimed to investigate the association of BP with different types of brain lesions and cognitive decline in patients with AF.

Overall, 1,213 AF patients underwent standardized brain magnetic resonance imaging at baseline and after 2 years, as well as yearly neurocognitive testing. BP was measured at baseline and categorized according to guidelines. New lesions were defined as new or enlarged brain lesions after 2 years. We defined cognitive decline using three different neurocognitive tests. Logistic and Cox regression analyses were performed to examine the associations of BP with new brain lesions and cognitive decline.

The mean age was 71 ± 8.4 years, 74% were male and mean BP was 135 ± 18/79 ± 12 mmHg. New ischemic lesions and white matter lesions were found in 5.4% and 18.4%, respectively. After multivariable adjustment, BP was not associated with the presence of new brain lesions after 2 years. There was no association between BP and cognitive decline over a median follow-up of 6 years when using the Montreal Cognitive Assessment or Digit Symbol Substitution Test. However, BP categories were inversely associated with cognitive decline using the Semantic Fluency Test, with the strongest association in patients with hypertension grade 1 [Hazard Ratio (95% Confidence Interval) 0.57(0.42 to 0.77)], compared to patients with optimal BP (p for linear trend: 0.025).

In a large cohort of AF patients, there was no association between BP and incidence of brain lesions after 2 years. Also, there was no consistent association between BP and cognitive decline over a follow-up of 6 years.

https://clinicaltrials.gov/study/NCT02105844, Identifier (NCT02105844).

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