Trajectories of Cognitive Decline Before and After New‐Onset Hypertension

Background Whether cognitive function declines before and shortly after new‐onset hypertension remains largely unknown. Methods and Results This prospective study used data from wave 2 (2004) to wave 9 (2018) of the English Longitudinal Study of Aging of participants who were free of hypertension at baseline. Our outcome variable was global cognitive z scores, derived from 3 cognitive tests: semantic fluency test, memory test, and orientation test. Over a median follow‐up of 13.6 years, 1121 (37.8%) participants developed hypertension. Using linear mixed models, we compared the trajectories of cognitive function before and after hypertension onset, with a concurrent control group without hypertension. The cognitive decline rate among those who later developed hypertension during the period before hypertension onset was similar to the rate among those who remained hypertension‐free throughout the study. Compared with the cognitive decline rate before hypertension, the rate of cognitive decline accelerated after the new onset of hypertension in global cognition (β, −0.019 SD/y [95% CI, −0.033 to −0.005]; P =0.007). Compared with participants developing hypertension between 55 and 64 years of age, those developing hypertension between 65 and 74 years of age experienced a more pronounced decline in global cognition after hypertension (β, −0.046 SD/y [95% CI, −0.077 to −0.014]; P =0.004). Conclusions Participants experienced accelerated cognitive decline upon developing new‐onset hypertension. Participants with older age at hypertension onset experienced an increased impact of cognitive decline following the onset of hypertension. Management of blood pressure in both midlife and later life may be crucial to protect cognitive health.