High visit‐to‐visit blood pressure variability predicts global cognitive decline: The Multi‐Ethnic Study of Atherosclerosis

Background Research of hypertension‐related risk factors for Alzheimer's disease has typically focused on blood pressure (BP) levels, despite evidence that high blood pressure variability (BPV) over time may predict poorer cardiovascular, neuropathological, and neurocognitive outcomes. We evaluated associations between BPV and cognitive function in the Multi‐Ethnic Study of Atherosclerosis (MESA). Methods Multivariable linear and logistic regression analyses of BP data across six examinations were used to determine associations that BPV (average real variability [ARV], variability independent of the mean [VIM]) and group‐based latent BP trajectories have with cognitive function, decline, and impairment, measured by the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span tests. Results Participants ( N = 1314; mean baseline age = 57) were 50% female, and 48% White. Higher systolic ( β = −0.06, 95% confidence interval [CI]: −0.12, −0.0001) and diastolic ( β = −0.08, 95% CI: −0.14, −0.02) ARV predicted increased global cognitive decline after covariate adjustment. Stronger relationships between BPV and global cognition were in older, White and Black participants, apolipoprotein E ( APOE ) ε4 non‐carriers, male participants, and non‐antihypertensive medication users. Conclusion Results suggest that higher systolic and diastolic BPV is an independent risk factor for cognitive dysfunction and decline in this multi‐ethnic cohort. This relationship differs across demographic and clinical characteristics.