Associations of Blood Pressure Trajectories with Subsequent Cognitive Decline, Dementia and Mortality

BACKGROUND: Hypertension may harm cognitive performance, but the potential correlates of longitudinal patterns of blood pressure (BP), especially diastolic BP (DBP), to cognition have been unclear. OBJECTIVES: To examine long-term BP trajectories in relation to subsequent cognitive decline, incident dementia and all-cause mortality in the general population. DESIGN: Population-based cohort study. SETTING: Communities in England. PARTICIPANTS: The study included 7566 participants from the English Longitudinal Study of Ageing (ELSA). MEASUREMENTS: BP were measured in 1998, 2004, 2008. Group-based trajectory modeling was used to identify long-term patterns of systolic BP (SBP) and DBP. Outcomes including cognitive function, incident dementia, and all-cause mortality were followed up to 10 years. RESULTS: Five distinct trajectories were identified for SBP and DBP, respectively. The normal-stable trajectory was used as the reference. For cognitive decline, both SBP and DBP trajectories were independently associated with subsequent cognitive decline, with the fastest decline appeared in the high-stable SBP group of 180 mmHg and the low-stable DBP group of 60 mmHg (both P<0.005). For incident dementia, the multivariable adjusted hazard ratio (HR) was also greatest in high-stable group (4.79, 95% confidence interval: 2.84 to 8.07) across all SBP trajectories. Conversely, low (HR: 1.58) and moderate-low stable (HR: 1.56) DBP trajectories increased dementia risk (both P<0.005). Similar patterns were found in BP trajectories in relation to all-cause mortality. CONCLUSION: Our study evaluates the potential health impact from different BP trajectories and suggests that controlling long-term SBP and maintaining adequate DBP may be relevant for the current practice to promote cognitive health and extend lifespan.