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Visit-to-visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline

Yue Qiao1, Zihan Sun2, Xunming Ji3

  • 1Department of Neurology, Xuanwu Hospital Capital Medical University, National Centre for Neurological Disorders, Beijing, China.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|July 31, 2026
PubMed

Insights

Higher blood pressure variability (BPV) is linked to faster cognitive decline, independent of average blood pressure (BP). This association was noted in intensive BP treatment arms, suggesting BPV may impact cognition differently based on treatment intensity.

Area of Science:

  • Cardiovascular Research
  • Neurology
  • Clinical Trials

Background:

  • Visit-to-visit blood pressure variability (BPV) may impact cognitive function beyond average blood pressure (BP).
  • The role of BPV in cognitive decline across different blood pressure treatment strategies is not well understood.

Purpose of the Study:

  • To investigate the association between systolic blood pressure variability independent of the mean (SBP-VIM) and cognitive decline.
  • To explore whether this association differs between intensive and standard blood pressure treatment contexts.

Main Methods:

  • Pooled individual participant data from ACCORD-MIND and SPRINT-MIND trials (n=11,104).
  • Assessed SBP-VIM as the primary exposure and annualized cognitive decline (Digit Symbol Substitution or Coding Test Z-scores) as the primary outcome.
  • Included baseline and follow-up cognitive testing and multiple BP measurements.

Main Results:

  • A 10% increase in SBP-VIM was independently associated with accelerated annual cognitive decline (β = -0.008 per year).
  • This association was observed in intensive blood pressure treatment arms but not in standard treatment arms.
  • The pooled interaction between SBP-VIM and treatment intensity was not statistically significant (p=0.054).

Conclusions:

  • Elevated systolic BPV is associated with faster cognitive decline, independent of mean systolic BP.
  • Exploratory findings suggest a potential differential impact of BPV on cognition based on treatment intensity, requiring further investigation.
Abstract

Keywords:
blood pressure controlblood pressure variabilitycognitive declinediabetes mellitushypertension

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