HYPERTENSION is a recognized cardiovascular risk factor linked to cognitive decline, especially in older adults. As blood pressure (BP) tends to fluctuate with age-related physiological changes, exploring the connection between visit-to-visit BP variability (BPV) and cognitive function is crucial. This study aimed to examine the relationship between BPV and cognitive outcomes in older adults, focusing on both systolic and diastolic BP.
Data from the Chicago Health and Aging Project, a population-based study conducted from 1993–2012, provided the foundation for this research. The study involved 4,770 individuals aged 65 and older, who had repeated blood pressure measurements taken every three years. BPV was calculated by summing the absolute differences between successive BP readings, divided by the number of assessments minus one. Cognitive function was assessed using standardized cognitive tests, with composite cognitive scores transformed into z-scores. Multivariable-adjusted linear regression models were employed to explore the association between BPV and cognitive scores.
Findings revealed that higher BPV, particularly in systolic BP, was associated with lower cognitive scores at the final follow-up. Of the 4,770 participants, 62.9% were women, 66.0% were Black, and the mean age at baseline was 71.3 years. Black participants exhibited higher systolic BPV (mean 17.7 mm Hg) compared to White participants (mean 16.0 mm Hg). In multivariable models, individuals in the third tertile of systolic BPV had lower cognitive scores by 0.074 standardized units (β −0.074; 95% CI −0.131 to −0.018), equating to approximately 1.8 years of cognitive aging. This relationship was observed to be more pronounced in Black participants, with those in the highest tertile of systolic BPV showing lower cognitive scores by 0.115 standardized units (β −0.115; 95% CI −0.183 to −0.047), corresponding to 2.8 years of cognitive aging.
Similar associations were found for diastolic BPV. The study emphasizes the importance of monitoring BPV, particularly in older Black adults, as elevated BPV appears to contribute to cognitive decline. These findings highlight the potential need for targeted interventions aimed at managing BPV to preserve cognitive function in aging populations.
Reference: Dhana A et al. Blood pressure variability and cognition in black and white older adults over 18 years of follow-up: a population-based cohort study. Neurology. 2025;104(1):e210151.
Katie Wright | AMJ
