Association Between Pulse Pressure and Cognitive Function: A Systematic Review and Meta-Analysis

Objective: To systematically review and meta-analyse evidence on the association between pulse pressure (PP), a surrogate of arterial stiffness, and specific cognitive domains. Design and method: PubMed, PsycInfo, Embase and Scopus were searched from inception to July 2025 using prespecified keywords and MeSH terms related to “pulse pressure” and “brain ageing”. Reference lists of included articles were screened. Studies were included if they reported an association between PP and cognitive function in adults. Reviews, protocols, animal and paediatric studies were excluded. Extracted data included sample size, participant characteristics, PP and cognitive measures, and effect estimates. Random-effects becomes Fixed-effects meta-analysis was performed in STATA using metan. Heterogeneity was assessed using I2 and publication bias using Egger's test. Results: The search identified 4,158 publications; 43 studies met inclusion criteria. Domains assessed were global cognition, memory, language, attention, executive function, processing speed and visuospatial ability. PP was positively associated with global cognition in meta-analysis in cross-sectional and longitudinal studies, with pooled standardised regression coefficients (beta) of 0.005 (P=0.0218; n=13,225) and 0.025 (P=0.0512; n=1,609) per SD increase in PP per 1 SD increase in global cognition, respectively. PP was negatively associated with memory in cross-sectional studies, with weaker evidence in longitudinal studies: beta -0.002 (P<0.0042; n=11,547) and -0.002 (P=0.0736; n=3,877) per SD increase in PP per 1 SD decrease in memory, respectively. Language was negatively associated with PP in cross-sectional studies (beta=-0.021; P<0.001; n=3,308). Cross-sectional analyses showed a negative association between PP and executive function (beta=-0.010; 95% CI -0.020 to -0.001; P=0.027; I2=66.8%; n=9,242). There was evidence of a negative association between PP and processing speed in cross-sectional analysis (beta=-0.001; P<0.001; n=5,828), with few longitudinal studies available. Evidence for associations with attention and visuospatial ability was limited. Conclusions: Meta-analysis suggests PP is positively associated with global cognition and negatively associated with memory. Findings for language, executive function and processing speed were negative in cross-sectional analyses, with limited or inconsistent longitudinal evidence. Further adequately powered longitudinal studies are needed.