Visit-to-visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension with or without type 2 diabetes (n=11104). Intervention: Visit-to-visit systolic blood pressure variability (SBP-VIM) vs. Lower systolic blood pressure variability. Primary outcome: Annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores (β=-0.008 per year, 95% CI -0.014 to -0.003).

Yue Qiao; Xunming Ji; Zihan Sun; Hugh Markus; Wenbo Zhao

doi:10.17863/cam.132038

July 16, 2026Open Access

Visit-to-visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline

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Key result

Greater visit-to-visit systolic BP variability is linked to faster annual cognitive decline.

β=-0.008 per year
95% CI -0.014 to -0.003
n=11,104

Why the study?

Visit-to-visit blood pressure variability may be associated with cognitive decline beyond mean BP, but its relevance across treatment contexts remains uncertain.

Does higher visit-to-visit systolic blood pressure variability accelerate cognitive decline in patients with high cardiovascular risk?

Key Points

To determine whether visit-to-visit systolic blood pressure variability is associated with cognitive decline independently of mean blood pressure, and to evaluate this relationship across different blood pressure treatment intensities.
Pooled individual-participant data from 11,104 participants across the SPRINT-MIND (NCT01206062) and ACCORD-MIND (NCT00000620) randomized trials with a median follow-up of 3.94 years.
Included participants with baseline and follow-up cognitive assessments and ≥3 blood pressure measurements from 3 months onward (mean of 12.0 measurements).
Evaluated primary exposure of systolic blood pressure variation independent of the mean (SBP-VIM) against annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores using linear mixed-effects models.
Each 10% increment in SBP-VIM was independently associated with faster annual cognitive decline (β=-0.008 per year; 95% CI, -0.014 to -0.003) after adjustment including mean systolic blood pressure.
Participants in the highest SBP-VIM tertile experienced a faster annual cognitive decline than those in the lowest tertile (β=-0.005 per year; 95% CI, -0.012 to -0.001; P-overall=0.005).
Faster cognitive decline occurred under intensive control in ACCORD-MIND (β=-0.035 per year; 95% CI, -0.063 to -0.007) and SPRINT-MIND (β=-0.013 per year; 95% CI, -0.021 to -0.005) but not standard control, though the pooled interaction was not statistically significant (P=0.054).

Study Design

Type

Cohort (n=11,104)

Multicenter

Yes

Structured PICO

Does higher visit-to-visit systolic blood pressure variability accelerate cognitive decline in patients with high cardiovascular risk?

P

Population

11,104 participants with hypertension (with or without diabetes) from the ACCORD-MIND and SPRINT-MIND trials, mean age 66.6 years, followed for a median of 3.94 years.

E

Exposure

Higher visit-to-visit systolic blood pressure variability (evaluated primarily as systolic BP variation independent of the mean [SBP-VIM]).

C

Comparator

Lower visit-to-visit systolic blood pressure variability.

O

Outcome

Annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores.surrogate

Main Result

Effect estimate: β=-0.008 per year (95% CI -0.014 to -0.003)

Higher visit-to-visit systolic blood pressure variability is independently associated with accelerated cognitive decline, suggesting that hemodynamic instability is a residual vascular risk factor for cognitive aging.

Limitations

High cardiovascular risk limits generalizability
Observational, post-hoc nature cannot entirely exclude residual confounding or reverse causality
Focused primarily on processing speed and executive function rather than global cognitive domains
Median follow-up of 3.94 years may be insufficient to capture long-term cumulative effects
Did not examine whether different classes of antihypertensive medications modify the relationship
Diabetes status was structurally linked to trial cohort
Participants were at high cardiovascular risk, which may limit generalizability to lower-risk populations.
Focused on processing speed and executive function rather than global cognitive domains.
Emphasized continuous cognitive decline rather than categorical outcomes such as incident mild cognitive impairment or dementia.
Median follow-up of 3.94 years may be insufficient to capture long-term cumulative effects or progression to dementia.
Did not examine whether different classes of antihypertensive medications modify the BPV–cognition relationship.
Diabetes status was structurally linked to trial cohort, preventing disentanglement of diabetes-specific effect modification from other trial-level differences.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Visit-to-visit SBP variability may mark faster cognitive decline beyond mean BP; extends prior associations but leaves open whether targeting it alters outcomes.

Abstract

INTRODUCTION: Visit-to-visit blood pressure variability (BPV) may be associated with cognitive decline beyond mean blood pressure (BP), but its relevance across treatment contexts remains uncertain. METHODS: We pooled individual-participant data from ACCORD-MIND and SPRINT-MIND trials (n=11,104). Participants had baseline and follow-up cognitive testing and ≥3 BP measurements from 3 months onwards. The primary exposure was systolic BP variation independent of the mean (SBP-VIM). The primary outcome was annualized change in standardize Digit Symbol Substitution or Coding Test Z-scores. RESULTS: Each 10% increment in SBP-VIM was independently associated with faster annual cognitive decline (β=-0.008 per year; 95% CI, -0.014 to -0.003) after adjustment including mean systolic BP. Associations were observed in the intensive but not standard BP treatment arms of both trials, although the pooled interaction was not statistically significant (P=0.054). DISCUSSION: Higher systolic BPV was associated with accelerated cognitive decline independently of mean BP. The exploratory treatment-context pattern warrants prospective confirmation. Trial registration: SPRINT-MIND: NCT01206062; ACCORD-MIND: NCT00000620 (ClinicalTrials.gov).

Discussion

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Cite This Study

Qiao et al. (2026) conducted a cohort in Hypertension with or without type 2 diabetes (n=11,104). Visit-to-visit systolic blood pressure variability (SBP-VIM) vs. Lower systolic blood pressure variability was evaluated on Annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores (β=-0.008 per year, 95% CI -0.014 to -0.003). Each 10% increment in visit-to-visit systolic blood pressure variability was independently associated with faster annual cognitive decline.

synapsesocial.com/papers/6a5b18b318557b26c203a65f https://doi.org/10.17863/cam.132038

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Visit-to-visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Visit-to-visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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