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Cited by 91Dementia and Cognitive Impairment ResearchBlood Pressure and Hypertension StudiesCardiovascular Health and Disease Prevention

Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans

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Levine, Deborah A., Galecki, Andrzej T., Langa, Kenneth M., Unverzagt, Frederick W., Kabeto, Mohammed U., Giordani, Bruno, Cushman, Mary, McClure, Leslie A. +2 more·2019·Hypertension
DOI 10.1161/hypertensionaha.118.12062PMC PMC6450556
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Abstract

Although the association between high blood pressure (BP), particularly in midlife, and late-life dementia is known, less is known about variations by race and sex. In a prospective national study of 22 164 blacks and whites ≥45 years without baseline cognitive impairment or stroke from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke), enrolled 2003 to 2007 and followed through September 2015, we measured changes in cognition associated with baseline systolic and diastolic BP (SBP and DBP), as well as pulse pressure (PP) and mean arterial pressure, and we tested whether age, race, and sex modified the effects. Outcomes were global cognition (Six-Item Screener; primary outcome), new learning (Word List Learning), verbal memory (Word List Delayed Recall), and executive function (Animal Fluency Test). Median follow-up was 8.1 years. Significantly faster declines in global cognition were associated with higher SBP, lower DBP, and higher PP with increasing age ( P<0.001 for age×SBP×follow-up-time, age×DBP×follow-up-time, and age×PP×follow-up-time interaction). Declines in global cognition were not associated with mean arterial pressure after adjusting for PP. Blacks, compared with whites, had faster declines in global cognition associated with SBP ( P=0.02) and mean arterial pressure ( P=0.04). Men, compared with women, had faster declines in new learning associated with SBP ( P=0.04). BP was not associated with decline of verbal memory and executive function, after controlling for the effect of age on cognitive trajectories. Significantly faster declines in global cognition over 8 years were associated with higher SBP, lower DBP, and higher PP with increasing age. SBP-related cognitive declines were greater in blacks and men.

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  • Systolic BP varies by sex.

    “We required participants to have 1 or more assessments of cognition and 1 or more measurements of blood pressure (BP) at or before the first measurement of cognition because BP is a risk factor for cognitive decline11,18 and varies by sex.18,19”

    From Sex differences in cognitive decline among US adults (2021) · cites this paper as [18]

    The Introduction (page unavailable) says men are more likely than women to have high blood pressure before age 50, with the disparity narrowing and reversing at older ages. That supports a sex difference in high blood pressure, but the passage does not establish that systolic blood pressure specifically varies by sex. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Systolic BP is a risk factor for cognitive decline.

    “We required participants to have 1 or more assessments of cognition and 1 or more measurements of blood pressure (BP) at or before the first measurement of cognition because BP is a risk factor for cognitive decline11,18 and varies by sex.18,19”

    From Sex differences in cognitive decline among US adults (2021) · cites this paper as [18]

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Authors
Levine, D. A., Galecki, A. T., Langa, K. M., Unverzagt, F. W., Kabeto, M. U., Giordani, B., Cushman, M., McClure, L. A., Safford, M. M., & Wadley, V. G.
Affiliations
  • University of Michigan (US)
  • From the Department of Internal Medicine (D.A.L., A.T.G., K.M.L., M.U.K.), University of Michigan Medical School, Ann Arbor
  • Indiana University Indianapolis (US)
  • University of Vermont (US)
  • Drexel University (US)
  • Weill Cornell Medicine (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-02
Volume
73
Issue
2
Pages
310-318
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hypertensionaha.118.12062
PMC
PMC6450556
OpenAlex
W2910684962
Cited by
91
References
11
Citations by year
2026: 7 · 2025: 13 · 2024: 10 · 2023: 13 · 2022: 15 · 2021: 14 · 2020: 16 · 2019: 3
FWCI
9.56
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • PMC
Funders
  • National Institute on Aging (P30AG053760, R01AG051827, P30AG024824)
  • National Institute of Neurological Disorders and Stroke (U01NS041588, R01NS102715)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
blood pressure, cognitive decline, systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure, racial differences, sex differences, African Americans, middle-aged and older adults, global cognition, verbal memory, executive function, learning, REGARDS cohort
MeSH terms
Age Factors, Aged, Blood Pressure, Female, Humans, Male, Memory, Middle Aged, Prospective Studies, Black People, White People, Executive Function, Cognitive Dysfunction

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