Key result
Hypertension history linked to ~122% higher risk of cognitive impairment in AF patients.
Why the study?
Cognitive impairment impairs daily activities, and the impact of hypertension history and blood pressure parameters on cognitive impairment in AF patients required evaluation.
Does a history of hypertension and elevated blood pressure parameters increase the risk of cognitive impairment in patients with atrial fibrillation?
Meta-Analysis (n=998,622)
Does a history of hypertension and elevated blood pressure parameters increase the risk of cognitive impairment in patients with atrial fibrillation?
Odds Ratio: 2.22 (95% CI 2.15–2.3)
p-value: p=<0.00001
A history of hypertension and high-normal blood pressure levels are significantly associated with an increased risk of cognitive impairment in patients with atrial fibrillation.
Hypertension history signals elevated cognitive impairment risk; confirms association in large meta-analysis but leaves open causal effects of treatment.
Background Cognitive impairment manifests as a gradual decline in the ability to perform daily activities. This study evaluates the impact of history of hypertension and blood pressure parameters on cognitive impairment in patients with atrial fibrillation (AF). Methods We systematically searched eight databases (CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science) from inception to September 7, 2025, for observational studies examining associations between hypertension history, blood pressure parameters, and cognitive impairment in AF patients. Study quality was assessed using NOS (cohort/case-control) and AHRQ (cross-sectional) tools. Meta-analyses were performed separately for odds ratios (OR) and hazard ratios (HR) using RevMan 5.4. Heterogeneity was evaluated with I 2 statistic, with sensitivity and subgroup analyses. Results A total of 20 studies involving 998,622 AF patients were included. We identified six potential risk factors for cognitive impairment in patients with atrial fibrillation from these 20 studies, three of which (history of hypertension, systolic blood pressure, diastolic blood pressure) were reported in sufficient studies to be included in a meta-analysis. Subgroup meta - analysis of OR showed that history of hypertension is associated with an increased risk of cognitive impairment in patients with atrial fibrillation (OR: 2.22, 95% CI: 2.15–2.30, P < 0.00001; I 2 = 4%).Further subgroup analyses indicated association between history of hypertension and the risk of mild cognitive impairment (OR = 2.06, 95% CI: 1.10–3.85, P = 0.02; I 2 = 59%), and between history of hypertension and overall cognitive impairment risk (OR = 2.22, 95% CI: 2.15–2.30, P < 0.00001; I 2 = 0%). Additionally, history of hypertension may increase the risk of dementia (OR = 4.88, 95% CI: 1.29–18.45, P = 0.02).The HR subgroup meta - analysis showed that high - normal blood pressure levels (130 - 139/85 - 89 mmHg) were significantly associated with cognitive impairment in AF patients (HR: 1.07, 95% CI: 1.01–1.13, P = 0.02; I 2 = 0%). Conclusion History of hypertension and high-normal blood pressure levels are significantly associated with cognitive impairment in patients with AF. Identifying and intervening in these modifiable risk factors is crucial for prevention and treatment. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251186104 , PROSPERO CRD420251186104.
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Mi et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=998,622). History of hypertension vs. No history of hypertension was evaluated on Cognitive impairment (OR 2.22, 95% CI 2.15-2.30, p=<0.00001). A history of hypertension was associated with a significantly increased risk of cognitive impairment in patients with atrial fibrillation (OR 2.22).
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