Key result
Higher visit-to-visit systolic BP variability is linked to faster cognitive decline independent of mean BP.
Why the study?
Visit-to-visit blood pressure variability may be associated with cognitive decline beyond mean blood pressure, but its relevance across treatment contexts remains uncertain.
Does higher visit-to-visit systolic blood pressure variability accelerate cognitive decline in patients with hypertension and/or diabetes?
Observational (n=11,104)
Yes
Does higher visit-to-visit systolic blood pressure variability accelerate cognitive decline in patients with hypertension and/or diabetes?
Mean Difference: -0.008 (95% CI -0.014–-0.003)
p-value: p=0.003
Higher visit-to-visit systolic blood pressure variability is independently associated with accelerated cognitive decline, suggesting that minimizing blood pressure fluctuations may be an important therapeutic target alongside mean blood pressure control.
Visit-to-visit SBP variability was associated with faster cognitive decline; leaves open whether targeting fluctuations improves outcomes beyond mean BP control.
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 Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) and Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND) (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 standardized 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% confidence interval [CI]: -0.014 to -0.003) after adjustment including mean SBP. 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.
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Qiao et al. (2026) conducted an observational in Hypertension (n=11,104). Visit-to-visit systolic blood pressure variability (SBP-VIM) vs. Lower visit-to-visit systolic blood pressure variability was evaluated on Annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores (β = -0.008, 95% CI -0.014 to -0.003, p=0.003). Each 10% increment in visit-to-visit systolic blood pressure variability was independently associated with faster annual cognitive decline (β = -0.008 per year) after adjustment for mean blood pressure.
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