Elevated Cumulative Blood Pressure is Associated With Cognitive Decline: A Nationwide Population-Based Cohort Study

Given that the evidence of a longitudinal association between cumulative blood pressure (BP) levels and cognitive function is inadequate and inconclusive, we conducted this study to determine whether higher cumulative BP was independently associated with subsequent cognitive decline and to evaluate the potential dose-response relationship between them. This cohort study used data from the 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS). All cognitive test scores were transformed into standardized z-scores, with negative values indicating worse performance. We used linear mixed models and restricted cubic splines to assess the association of cumulative BP levels with cognitive function. A total of 7877 participants were included (mean [SD] age, 58.4 [9.0] years; 46.8% men; median follow-up duration, 6.9 [IQR, 3.8-7.0] years). After controlling for multiple factors, compared with the lowest quartile, the highest quartiles of cumulative systolic BP (SBP, β = -0.096 SD/year, 95% CI: -0.149 to -0.044) and pulse pressure (PP, β = -0.099 SD/year, 95% CI: -0.154 to -0.043) were independently associated with faster cognitive decline, whereas no significant association was observed for diastolic BP (DBP, β = -0.023 SD/year, 95% CI: -0.075 to 0.029). Each SD increment in cumulative SBP and PP, but not DBP, was also associated with accelerated cognitive decline. Additionally, nonlinear dose-response relationships were observed between cumulative SBP and DBP levels and the rate of cognitive decline (all p < 0.05). In conclusion, elevated cumulative SBP and PP, but not DBP, were independently associated with accelerated cognitive decline among middle-aged and older Chinese adults.