What is the clinical evidence from this study?

Study design: Cohort. Population: Cognitive impairment (n=4062). Intervention: Cumulative systolic blood pressure (highest quartile) vs. Lowest quartile of cumulative systolic blood pressure. Primary outcome: First occurrence of cognitive impairment (HR 1.85, 95% CI 1.33-2.59, p=<0.001).

November 6, 2025BMC Geriatrics4 citationsOpen Access

Association between cumulative blood pressure and the risk of cognitive impairment in Chinese older adults: a longitudinal study over 16 years

Q: What are the key findings of this study?

Elevated cumulative systolic blood pressure significantly increased the risk of subsequent cognitive impairment, with the highest quartile demonstrating an 85% higher risk compared to the lowest quartile (HR 1.85).

YGYing GaoShenyang Pharmaceutical University PZPeng ZhangTianjin Medical University General Hospital HYHongxi YangTianjin Medical University

Key Result

Elevated cumulative systolic blood pressure significantly increased the risk of subsequent cognitive impairment, with the highest quartile demonstrating an 85% higher risk compared to the lowest quartile (HR 1.85).

Study Design

Type

Cohort (n=4,062)

Multicenter

Yes

Structured PICO

Does higher cumulative blood pressure increase the risk of cognitive impairment in cognitively healthy Chinese older adults?

Population

4,062 cognitively healthy Chinese older adults aged 65 and older were followed for a median of 6.2 to 7.0 years to evaluate the association between cumulative blood pressure and incident cognitive impairment.

Exposure

Highest quartile of cumulative systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) calculated as the area under the curve.

Comparator

Lowest quartile of cumulative systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP).

Outcome

Cognitive impairment (defined according to the years of schooling and total cognitive scores during the follow-up periods).

Elevated cumulative systolic, diastolic, and pulse pressure over time independently increase the risk of subsequent cognitive impairment in older adults.

Main Result

Hazard Ratio: 1.85 (95% CI 1.33–2.59)

p-value: p=<0.001

Limitations

Lack of clinical diagnosis of dementia, preventing examination of incident dementia
Cognitive assessment relied on isolated tasks (MMSE) which may have limited sensitivity for capturing nuanced cognitive decline
High proportion of excluded older adults (primarily older women with lower education and poorer health) could contribute to selection bias
Possibility of unmeasured and residual confounding
Antihypertensive medication use was not collected in earlier survey waves

Abstract

BACKGROUND: Cumulative blood pressure (BP), which takes into account both the magnitude and duration of BP exposure, is linked to cognitive impairment. However, this association remains unclear in Chinese older adults. The critical level of cumulative BP associated with significantly increased cognitive impairment risk remains elusive. Thus, this study aims to investigate the association between cumulative BP levels and the risk of cognitive impairment in Chinese older adults. METHODS: The Chinese Longitudinal Healthy Longevity Survey (CLHLS) over 16 years was divided into two consecutive sub-cohorts, namely the 2002 sub-cohort from 2002 to 2011 and the 2008 sub-cohort from 2008 to 2018. Cumulative BP exposures were calculated as the area under the curve derived from two consequence BP measurements and their corresponding time intervals. Cognitive impairment was defined according to the years of schooling and total cognitive scores of older adults during the follow-up periods. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of cognitive impairment across quartiles of cumulative BP were estimated using multivariable Cox proportional hazard models. Finally, potential dose-response relationships were examined using restricted cubic splines. RESULTS: A total of 2,142 and 1,920 cognitively healthy older adults participants from the two sub-cohorts were included in the analysis, respectively. Over a median follow-up of 6.2 years (IQR 6.1–6.3) and 7.0 years (IQR 6.8–7.2), 542 and 347 older adults experienced cognitive impairment in the two sub-cohorts, respectively. Higher cumulative systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were significantly associated with a higher risk of cognitive impairment (all Ptrend <0.01). Compared to the lowest quartile in the two sub-cohorts, the HRs (95%CIs) for cognitive impairment risk in the highest quartile were 1.85 (1.33–2.59) and 2.64 (1.76–3.97) for cumulative SBP, 2.00 (1.45–2.75) and 2.20 (1.46–3.33) for cumulative DBP, and 1.59 (1.16–2.18) and 2.10 (1.42–3.10) for cumulative PP, respectively. Linear dose-response patterns were observed for the association between the risks of cognitive impairment with all three cumulative BP levels in both two sub-cohorts. Moreover, cumulative SBP increased from 387.8 mm Hg × year to 416.4 mm Hg × year over 6 years, whilst cumulative PP increased from 138.7 mm Hg × year to 170.8 mm Hg × year—equivalent to a mean SBP increase from 131.0 mm Hg to 134.8 mm Hg and mean PP increase from 46.9 mm Hg to 55.3 mm Hg—which collectively increased the risk of cognitive impairment. In contrast, cumulative DBP was maintained at 245 mm Hg × year over 6 years, whereas the mean DBP progressively decreased from 82.9 mm Hg to 79.3 mm Hg, showed a significant association with cognitive impairment. CONCLUSIONS: Elevated cumulative SBP, DBP, and PP independently increased subsequent cognitive impairment risk in Chinese older adults.

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