Discussion

Our findings were based on a dataset of participants spanning adolescents to

geriatrics which were drawn from the general population of a selected community in
Manila. Since a large part of our study sample consisted of young and middle-aged
adults, neurodegenerative or atherosclerotic changes will not have been a major
confounder, which is a strength of the current study. However, our study also
suffered some limitations. First, we were not able to consider the hypotheses
involving age at onset and duration. Thus, it is possible that our results tend to
underestimate the association between hypertension and cognitive impairment, and
could bias our results to the finding of no association.
Previous studies of cognition and blood pressure have generally measured
one or the other. Prior studies have evaluated differences in association by age at
baseline/assessment of blood pressure. For example, data from the Adult Changes
in Thought Study suggested an adverse association between elevated blood
pressure and dementia only in those under age 75 at baseline (Li et al., 2007).
Similarly, in a study conducted by Euser et al. in 2009, despite 11 years of follow-
up in each group, researchers found no association between cognitive function and
blood pressure in those ages 55-64 at baseline, an adverse association in those
ages 65-74 at baseline, and a protective association in those over 75 at baseline.
While these studies seemingly support an association between cognition and age at
onset of hypertension, their results may also be accounted for by shorter duration of
hypertension.
Similarly, previous studies have considered duration of hypertension without
considering age at onset. For example, longer duration of anti-hypertensive drug
usage predicted reduced risk of cognitive decline or dementia in hypertensive men
from the Honolulu Asia Aging Study (Peila et al., 2006) ; In the Framingham Heart
Study, hypertensive patients who showed a greater proportion of study visits and a
higher average blood pressure predicted worse cognitive function among those not
taking anti-hypertensive medications two years prior to cognitive assessment
(Farmer, 1990); Similarly, participants from the Epidemiology of Vascular Aging
Study who had consistently elevated blood pressure at study visits two years apart
were more likely to exhibit demonstrable cognitive decline than those who returned
to normotension at the second visit (Tzourio, 1990).
Likewise, we were unable to quantify the impact of anti-hypertensive
medication use and level of blood pressure control. Such factors would be of interest
but were beyond the scope of this study. While we were able to consider many
potential confounders, we did not have longitudinal information on diet or physical
activity, and so our results may be subject to confounding if these factors play an
important role in cognitive change independent of other comorbidities.
Thus, we conclude that across a wide age range, BP level is not associated
with cognitive function in a clinically significant way. This does not diminish the
implication of the possible use of treating BP to prevent atherosclerotic and
neurodegenerative disease in older age, but it also suggests that there are no
immediate cognitive benefits from lowering BP per se. This also suggests the
inclusion of a wide set of confounding factors and strict measurements of both BP
and cognitive function for future studies.
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