Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies

Shahab Haghayegh; Ramon C. Hermida; Michael H. Smolensky; Mili Jimenez Gallardo; Claudia Duran-Aniotz; SLACHEVSKY CHONCHOL, ANDREA MARÍA; BEHRENS PELLEGRINO, MARIA ISABEL; David Aguillon; Hernando Santamaria-Garcia; Adolfo M. García; Diana Matallana; Agustín Ibáñez; Kun Hu

doi:10.3390/clockssleep7010011

Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies

Journal

Clocks & Sleep

ISSN

2624-5175

Date Issued

2025-03-06

Author(s)

Shahab Haghayegh

Ramon C. Hermida

Michael H. Smolensky

Mili Jimenez Gallardo

Claudia Duran-Aniotz

SLACHEVSKY CHONCHOL, ANDREA MARÍA

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

BEHRENS PELLEGRINO, MARIA ISABEL

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

David Aguillon

Hernando Santamaria-Garcia

Adolfo M. García

Diana Matallana

Agustín Ibáñez

Kun Hu

Type

journal-article

DOI

10.3390/clockssleep7010011

URL

https://hdl.handle.net/123456789/11341

Abstract

Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer’s disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia.

Cite this document

Haghayegh, S., Hermida, R. C., Smolensky, M. H., Jimenez Gallardo, M., Duran-Aniotz, C., Slachevsky, A., Behrens, M. I., Aguillon, D., Santamaria-Garcia, H., García, A. M., Matallana, D., Ibáñez, A., & Hu, K. (2025). Critical review of the methodological shortcoming of ambulatory blood pressure monitoring and cognitive function studies. Clocks & Sleep, 7(1), 11. https://doi.org/10.3390/clockssleep7010011