Blood pressure levels and incident motoric cognitive risk syndrome in older Chinese adults: a longitudinal cohort study using CHARLS data

Motoric cognitive risk syndrome (MCR) is a predementia risk phenotype characterized by subjective cognitive decline and slow gait. Blood pressure is an easily measurable and modifiable vascular factor, but the associations of specific blood pressure indices with MCR remain unclear. A total of 4,865 adults aged 60 years or older were included. Blood pressure indices included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Multivariable logistic regression was used to examine the associations between baseline blood pressure indices and MCR. After excluding participants with MCR at baseline, Cox proportional hazards models were used to evaluate the associations between blood pressure levels and incident MCR. Visit-to-visit blood pressure variability and hypertension burden were additionally evaluated. Restricted cubic spline analyses, cumulative blood pressure exposure analyses, lagged exposure models, subgroup analyses, and sensitivity analyses were further performed. The prevalence of MCR was 16.4% in Chinese older adults. Higher SBP (OR 1.114[1.030, 1.205]), DBP (OR 1.130[1.046, 1.221]), and MAP (OR 1.133[1.048, 1.225]) were positively associated with MCR. Cox analyses showed that higher SBP (HR 1.100[1.015, 1.193]), DBP (HR 1.128[1.039, 1.224]), and MAP (HR 1.123[1.036, 1.219]) were associated with an increased risk of incident MCR. Cumulative exposure analyses further showed that average SBP (HR 1.202[1.056, 1.367]), DBP (HR 1.196[1.055, 1.355]), and MAP (HR 1.222[1.075, 1.390]) from 2011 to 2015 were associated with incident MCR. SBP and MAP variability were consistently associated with incident MCR, whereas hypertension burden was sensitive to its definition. In lagged exposure models, higher DBP (OR 1.091[1.000, 1.190]) and MAP (OR 1.100[1.005, 1.204]) in the preceding wave were associated with a higher subsequent risk of MCR. Higher blood pressure levels were associated with increased risks of MCR and incident MCR, whereas hypertension status and burden showed less consistent associations. These findings suggest that blood pressure levels and their longitudinal variability capture information not fully reflected by hypertension diagnosis alone. Not applicable.