Blood pressure and cognitive decline over the course of 2 years in elderly people: a community-based prospective cohort study

Background: Numerous studies have shown a significant association between blood pressure (BP) and cognition, but little is known about the effect of BP on the rate of cognitive decline. Aims: To investigate the relationship between blood pressure and the subsequent rate of cognitive decline in elderly people. Methods: Based on a prospective cohort that has been followed since 2014, we collected baseline blood pressures and other covariates in 7874 Chinese individuals aged 60 years or older, and followed their cognitive change using the Mini-Mental State Examination (MMSE) until Dec 31, 2016. Linear mixed-effects models were used to measure changes in MMSE scores over time in relation to blood pressure values, and in addition to the covariates, we included random effects for intercepts and slopes. Results: In the non-hypertension group, we observed that faster cognitive decline was associated with higher systolic blood pressure, lower diastolic blood pressure, lower mean arterial pressure, and higher pulse pressure. In the hypertension group, lower diastolic blood pressure, lower mean arterial pressure, and higher pulse pressure were associated with faster cognitive decline, but not systolic blood pressure. Conclusion: Higher systolic blood pressure, lower diastolic blood pressure, lower mean arterial pressure, and higher pulse pressure accelerate the subsequent rate of cognitive decline in elderly people. The results of this study may help improve blood-pressure control strategies to prevent cognitive decline.