Systolic Blood Pressure and Cognition in the Elderly: The Northern Manhattan Study

J Alzheimers Dis. 2021;82(2):689-699. doi: 10.3233/JAD-210252.

Abstract

Background: Increasing evidence suggests that hypertension is a risk factor for cognitive impairment and dementia. The relationship between blood pressure and cognition in a racially and ethnically diverse population remains unclear.

Objective: To study association of blood pressure with cognition cross-sectionally and longitudinally in the elderly.

Methods: Participants are stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (NOMAS) (n = 1215). General linear models are constructed to examine blood pressure in relation to cognition cross-sectionally and longitudinally at a five-year follow-up.

Results: We found a cross-sectional association of systolic blood pressure (SBP) with word fluency/semantic memory, executive function, and processing speed/visual motor integration (VMI) function. This association was independent of demographics, vascular risk factors, white matter hyperintensity volume (WMHV), and carotid intima-media thickness (cIMT). The cross-sectional association of SBP with processing speed/VMI and executive function was attenuated after adjusting anti-hypertension medications in the models. Baseline SBP was associated with the change of processing speed/VMI function after adjusting vascular risk factors, WMHV, and cIMT at a 5-year follow-up. This longitudinal association was not found after adjusting anti-hypertension medications in the models. Further analyses revealed that individuals with category SBP from < 120 mmHg to≥140 mmHg had a linear decline in processing speed/VMI function at a 5-year follow-up.

Conclusion: We show that SBP is negatively associated with cognition cross-sectionally and longitudinally in the elderly. Anti-hypertension treatment eliminates the negative association of SBP with processing speed/VMI function longitudinally. Our findings support the treatment of stage 1 systolic hypertension in the elderly.

Keywords: Cognition; northern manhattan study (NOMAS); race/ethnicity; systolic blood pressure.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure Determination
  • Cognition / physiology*
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / ethnology
  • Cognitive Dysfunction* / physiopathology
  • Correlation of Data
  • Cross-Sectional Studies
  • Executive Function / physiology*
  • Female
  • Humans
  • Hypertension* / diagnosis
  • Hypertension* / drug therapy
  • Hypertension* / ethnology
  • Hypertension* / psychology
  • Longitudinal Studies
  • Male
  • Mental Processes / physiology
  • Risk Factors
  • United States / epidemiology

Substances

  • Antihypertensive Agents