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Updated: Jun 18, 2026

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
07:30

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Published on: April 23, 2021

Blood pressure parameters and cognitive decline and dementia after stroke or transient ischemic attack: results from

Sultana Shajahan1, Mark Woodward1,2, Craig S Anderson1,3,4

  • 1The George Institute for Global Health, The University of New South Wales, Sydney, Australia.

American Journal of Hypertension
|June 16, 2026
PubMed

Insights

Blood pressure variability and load, not just mean systolic pressure, are linked to increased dementia risk. These findings highlight potential new targets for dementia prevention strategies.

Area of Science:

  • Neurology
  • Cardiology
  • Gerontology

Background:

  • Elevated blood pressure (BP) parameters, including mean systolic BP, BP variability, pulse pressure (PP), and mean arterial pressure (MAP), are potential targets for dementia prevention.
  • The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial provided data to investigate these associations in patients with stroke or transient ischemic attack.

Purpose of the Study:

  • To investigate the association between various blood pressure parameters and the risk of cognitive decline or dementia.
  • To identify specific BP metrics that may serve as important targets for dementia prevention strategies.

Main Methods:

  • Blood pressure parameters were calculated from measurements taken over 18 months on six occasions.
  • Risk of cognitive decline/dementia was assessed using Mini-Mental State Examination scores and adjudicated outcomes.
  • Modified Poisson regression models with log link were employed to calculate risks per 1-standard deviation increase in BP parameters, with subgroup analyses by mild cognitive impairment (MCI), sex, and stroke subtype.

Main Results:

  • Higher mean, maximum, cumulative load, and last measure of systolic BP (SBP) were associated with increased risk of cognitive decline/dementia, with mean SBP showing the highest risk (RR 1.18).
  • For diastolic BP, higher mean, maximum, variability, cumulative load, slope, and last measure were associated, with load demonstrating the strongest association (RR 1.23).
  • Mean PP (RR 1.11) and MAP load (RR 1.20) were also associated with increased risk. BP variability showed higher risk in participants without MCI.

Conclusions:

  • Beyond mean SBP, increased variability, cumulative load, slope, and last measures of diastolic BP, PP, and MAP are associated with a higher risk of cognitive decline and dementia.
  • These findings suggest that BP variability and load are significant risk factors for cognitive decline, offering potential new avenues for dementia prevention.
Abstract

Keywords:
blood pressurecognitive declinedementiapulse pressurestroke

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