Temporal patterns of cognitive decline after hypertension onset among middle-aged and older adults in China

Fig. 1. Flowchart of sample selection.

Fig. 2. Predicted changes in global cognition z-scores over time. The predicted values were derived from the results of the mixed-effects model regression (Table 2), which adjusted for random intercepts and slopes for baseline age, gender, body mass index (BMI), instrumental activities of daily living (IADLs) score, education level, residential area (rural or urban), marital status, smoking, alcohol use, hyperlipidemia, cancer, diabetes, myocardial infarction, lung disease, depressive symptoms, time (years), the time-varying hypertension variable (all subjects were hypertension-free at baseline), and the time variable representing the time (years) after new-onset hypertension. The predicted cognitive scores are calculated for a 60-year-old woman with the following characteristics: she completed primary education, resides in a rural area, is married, and does not currently smoke or drink. She does not have diabetes, dyslipidemia, lung diseases, heart attack, cancer, or depression. Her IADL score is 0. She developed hypertension at the end of the third year.

Fig. 3. Estimated changes in z-scores of different cognitive tests over time. The predicted values were derived from the results of the mixed-effects model regression (Table 2), which adjusted for random intercepts and slopes for baseline age, gender, body mass index (BMI), instrumental activities of daily living (IADLs) score, education level, residential area (rural or urban), marital status, smoking, alcohol use, hyperlipidemia, cancer, diabetes, myocardial infarction, lung disease, depressive symptoms, time (years), the time-varying hypertension variable (all subjects were hypertension-free at baseline), and the time variable representing the time (years) after new-onset hypertension. The predicted cognitive scores are calculated for a 60-year-old woman with the following characteristics: she completed primary education, resides in a rural area, is married, and does not currently smoke or drink. She does not have diabetes, dyslipidemia, lung diseases, heart attack, cancer, or depression. Her IADL score is 0. She developed hypertension at the end of the third year.

Fig. 4. Post-hypertension annual decline in global cognitive z-scores after hypertension onset, according to subgroups defined by covariates. *After adjusting for baseline age, gender, body mass index (BMI), instrumental activities of daily living (IADLs) score, education level, residential area (rural or urban), marital status, smoking, alcohol use, hyperlipidemia, cancer, diabetes, myocardial infarction, lung disease, depressive symptoms, time (years), the time-varying hypertension variable (all subjects were hypertension-free at baseline), and the time variable representing the time (years) after new-onset hypertension, except where an adjusting variable was itself being tested.