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64/100

✓ Peer-reviewed alzhub usefulness score 64 out of 100. Mild cognitive impairment

Topic: Risk, prevention and care in population studies

Importance The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. Objective To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). Design, setting, and participants Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. Main outcomes and measures Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. Results We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. Conclusions and relevance Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

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APA 7th

Mossello, E., Pieraccioli, M., Nesti, N., Bulgaresi, M., Lorenzi, C., Caleri, V., et al. (2015). Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2014.8164

Vancouver

Mossello E, Pieraccioli M, Nesti N, Bulgaresi M, Lorenzi C, Caleri V, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA internal medicine. 2015. doi:10.1001/jamainternmed.2014.8164. PMID: 25730775.

BibTeX

@article{mossello2015-25730775,
  author  = {Mossello, E. and Pieraccioli, M. and Nesti, N. and Bulgaresi, M. and Lorenzi, C. and Caleri, V. and Tonon, E. and Cavallini, M. C. and others},
  title   = {{Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs}},
  journal = {JAMA internal medicine},
  year    = {2015},
  doi     = {10.1001/jamainternmed.2014.8164},
  pmid    = {25730775},
  url     = {https://doi.org/10.1001/jamainternmed.2014.8164}
}

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Key findings

Results We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4).
Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003).
The association was significant in the dementia and MCI subgroups only among patients treated with AHDs.
In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups.
Other ambulatory blood pressure monitoring variables were not associated with MMSE score change.

Why it matters

In this cohort of 172 patients with dementia or MCI, those on blood pressure drugs with the lowest daytime systolic blood pressure had greater cognitive decline over about nine months. This suggests that overly low blood pressure may be harmful in treated patients, but it does not test a treatment for Alzheimer's disease itself.

Study details

Study designcohort study
Participants172
Effect size68.0%; 32.0%; 69.8%
Evidence strengthModerate

How this study scored 64/100

Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomized / blinded because the record does not state it.

Component	Points	Why
Journal tier	9 / 10	Tier 2 — leading specialty journal (JAMA internal medicine)
Journal's citation record	3 / 4	JAMA Internal Medicine: journal h-index 258 (OpenAlex, 2026-10-29)
Study design	7 / 12	A cohort study following people over time
Strength of evidence	3 / 5	Rated “moderate” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	2015 — within 20 year(s) of the newest study here
Sample size	2 / 4	172 participants
Effect reported	2 / 3	Effect reported as a number, without an interval or test
Studied in people	3 / 3	Studied in people (participant count stated)
Randomized / blinded	0 / 2	No randomization or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	5 / 7	Cited 247 times (OpenAlex, 2026-10-10)
Citations per year	3 / 5	19.0 citations a year over 13 year(s) since 2015
Impact for its field and year	5 / 6	Cited 24.0× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	2 / 6	Cited by 5 other studies in this library
Still being cited	2 / 4	Cited 33 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	3 / 4	Last-listed author Andrea Ungar: h-index 56 (OpenAlex, whole career)
Institution's track record	1 / 3	University of Florence: institution h-index 739 (OpenAlex)
Multicenter collaboration	1 / 3	OpenAlex lists 2 institution(s) in 1 country
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 25730775)
Free to read	0 / 2	Behind a paywall — scores zero
Total	64 / 100	—

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