Non-Pharmacological Interventions for Cognitive Function Management in Middle-Aged and Older Adults with Hypertension: A Scoping Review

Background: Hypertension is an increasing public health concern across adulthood, including among young adults, and remains highly prevalent in middle-aged and older populations. In this review, middle-aged adults were defined as individuals aged 45 years or older, and older adults as individuals aged 60 years or older. Hypertension is also a modifiable vascular risk factor for cognitive decline and dementia, and cognitive impairment is common among patients with hypertension. Persistent blood pressure elevation may impair cognition through vascular injury, cerebral hypoperfusion and small-vessel disease. Non-pharmacological strategies such as exercise, lifestyle modification, sleep management, psychological support, cognitive rehabilitation and nursing follow-up may support both blood pressure management and cognitive health, but the evidence is scattered across heterogeneous populations and interventions. Methods: A scoping review-style evidence mapping was conducted with reference to the Arksey and O'Malley framework, subsequent methodological guidance, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic search of Chinese and English databases was conducted from the earliest available record in each database to June 2026. Studies were eligible if they involved middle-aged or older adults with hypertension or hypertension-related cognitive risk, evaluated a non-pharmacological intervention, and reported at least one cognitive outcome. Data were charted on population, study design, intervention components, duration, outcome measures and main findings. Findings were synthesized narratively and thematically. Results: Only eight intervention studies, representing a total of 932 participants, met the inclusion criteria, indicating a limited evidence base. Study designs included randomized controlled or randomized intervention studies, a quasi-experimental pretest-posttest study, a prospective controlled community study, a follow-up analysis of a randomized trial, and nursing intervention studies. Four intervention themes were identified: exercise-based interventions, lifestyle and sleep management, health education with emotional or psychological support, and cognitive rehabilitation with continuing nursing management. Potential benefits were reported for memory, working memory, global cognition, activities of daily living, quality of life, blood pressure control, adherence or self-management. However, the included studies varied substantially in population, intervention intensity, duration, study design and outcome measures. Conclusion: The available evidence suggests that non-pharmacological interventions may have potential benefits for cognitive and related clinical outcomes in adults with hypertension, but the findings should be interpreted cautiously because only eight heterogeneous intervention studies were identified. Current evidence is insufficient to determine the most effective intervention components or delivery models. Larger, well-designed studies with standardized cognitive outcomes, longer follow-up and clearly reported intervention intensity and adherence are needed.