BP Variability Tied to Cognitive Decline

TOPLINEHigher visit-to-visit systolic blood pressure (BP) variability was independently associated with faster cognitive decline in adults at elevated cardiovascular risk, regardless of mean BP levels in a study.METHODOLOGYResearchers conducted a pooled individual-participant analysis including 11,104 participants from two randomized controlled trials: the SPRINT-MIND (n = 9361; hypertensive adults without diabetes) and ACCORD-MIND (n = 2809; adults with type 2 diabetes).Participants had baseline and follow-up cognitive assessments using the Digit Symbol Coding Test (SPRINT-MIND) or Digit Symbol Substitution Test (ACCORD-MIND). Visit-to-visit systolic BP variability was calculated using SBP readings from the 3-month visit through the final cognitive assessment.Systolic BP variability was quantified using variation independent of mean (VIM) as the primary metric, with SD, coefficient of variation, and average real variability as alternative metrics.The primary outcome was the longitudinal change in global cognitive performance over time, quantified as the annual rate of change in standardized DSST/DSCT Z-score.Median follow-up was 3.94 years; participants contributed a mean of 12.0 BP measurements over the study period.TAKEAWAYEach 10% increment in systolic BP variation independent of mean was associated with an additional annual decline of 0.008 Z-score units (P = .003) after full adjustment including mean systolic BP.Participants in the highest tertile of systolic BP variability exhibited a faster rate of cognitive decline compared with those in the lowest tertile (regression coefficient, β = −0.005 per year; P = .049).Exploratory stratified analyses suggested the adverse association between BP variability and cognitive decline appeared more pronounced under intensive BP control (ACCORD-MIND β = −0.035 per year; 95% CI, −0.063 to −0.007; SPRINT-MIND β = −0.013 per year; 95% CI, −0.021 to −0.005), although the pooled three-way interaction did not reach statistical significance.The spline curves demonstrated approximately linear dose-response relationships between all BP variability metrics and cognitive decline, with no evidence of nonlinearity (P for nonlinearity = .925 for VIM).IN PRACTICE"These findings identify BPV as a potential vascular contributor to cerebral end-organ injury beyond conventional BP control," the authors of the study wrote.SOURCEThe study was led by Yue Qiao, Department of Neurology, Xuanwu Hospital Capital Medical University, National Centre for Neurological Disorders in Beijing, China. It was published online on July 31, 2026, in Alzheimer's & Dementia.LIMITATIONSThe findings may not be generalizable to lower-risk populations. The analysis focused on processing speed and executive function rather than global cognitive domains and emphasized continuous decline rather than categorical outcomes such as incident mild cognitive impairment or dementia. Follow-up was short to capture cumulative effects or progression to dementia. The study did not evaluate the association between different antihypertensive medication classes and the BP variability–cognition relationship.DISCLOSURESThe study was supported by grants from the National Major Science and Technology Projects of Brain Science and Brain-inspired Intelligence Young Scientist Class A, the National Natural Science Fund of China, the British Heart Foundation, and the Fundamental and Interdisciplinary Disciplines Breakthrough Plan of the Ministry of Education of China. Infrastructural support was provided by the Cambridge British Heart Foundation Centre of Research Excellence and the Cambridge University Hospitals National Institute for Health and Care Research Biomedical Research Centre. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.