Could fluctuations in blood pressure in later life signal a greater risk of cognitive decline?

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Understanding how long-term blood pressure patterns relate to the brain and cognition is increasingly recognized as important. This longitudinal population study investigated repeated blood pressure measurements in relation to changes in cognitive performance over 12 years and imaging data at 12 years.

The study included two cohorts, one in midlife and one in later life. Using linear regression, researchers examined systolic and diastolic blood pressure, changes in blood pressure between visits, and visit-to-visit variability in relation to cognitive change and imaging at 12 years.

Cognitive-change data were available for 1,054 midlife participants, whose baseline age was 42.7 years (SD 1.5), and 1,233 later-life participants, whose baseline age was 62.5 years (SD 1.5). Imaging data were available for 168 midlife participants and 233 later-life participants.

After adjustment for multiple comparisons, greater diastolic blood pressure variability in later life was associated with a −1.95-point change on an attention-based task (95% CI, −2.89 to −1.01) and a −0.42-point change on a psychomotor task (95% CI, −0.68 to −0.15), both indicating declines in performance. A higher standard deviation (SD) of diastolic blood pressure across follow-up was also associated with greater white matter hyperintensity volume. The abstract reports the percentage increase in volume per 10 mm Hg increase in SD as 1.50 (95% CI, 1.16–1.94).

In this largely normotensive or mildly hypertensive population, the analyses found no relationships between blood pressure and cognition in midlife. The researchers concluded that diastolic blood pressure variability in later life may be a risk marker for cognitive decline. This may indicate an at-risk period, or a way to identify an at-risk population, at the age when diastolic blood pressure is starting to decline.