Pulse pressure was positively associated with global cognition (beta 0.005; P=0.0218) but negatively associated with memory (beta -0.002; P<0.0042) in cross-sectional meta-analyses.
Meta-Analysis
Is pulse pressure associated with changes in specific cognitive domains in adults?
Higher pulse pressure is associated with worse memory but shows a slight positive association with global cognition, highlighting the need for robust longitudinal studies to clarify the impact of arterial stiffness on brain aging.
Effect estimate: beta 0.005
p-value: p=0.0218
Objective: To systematically review and meta-analyse evidence on the association between pulse pressure (PP), a surrogate of arterial stiffness, and specific cognitive domains. Design and method: PubMed, PsycInfo, Embase and Scopus were searched from inception to July 2025 using prespecified keywords and MeSH terms related to ’pulse pressure’ and ’brain ageing’. Reference lists of included articles were screened. Included studies reported an association between PP and cognitive function in adults. Reviews, protocols, animal and paediatric studies were excluded. Data extracted included sample size, participant characteristics, PP, cognitive measures, and effect estimates. Random-effects meta-analysis was performed in STATA using the metan function. Heterogeneity was assessed using I2 and publication bias by Egger's test. Results: The search identified 4,158 publications; 43 studies met the inclusion criteria. Domains assessed were global cognition, memory, language, attention, executive function, processing speed and visuospatial ability. PP was positively associated with global cognition in meta-analysis in cross-sectional and longitudinal studies, with pooled standardised beta regression coefficients of 0.005 (P=0.0218; n=13,225) and 0.025 (P=0.0512; n=1,609) per SD increase in PP per 1 SD increase in global cognition, respectively. PP was negatively associated with memory in cross-sectional studies, with weaker evidence suggested by longitudinal studies: beta -0.002 (P<0.0042; n=11,547) and -0.002 (P=0.0736; n=3,877) per SD increase in PP per 1 SD decrease in memory, respectively. Language was negatively associated with PP in cross-sectional studies (beta=-0.021; P<0.001; n=3,308). Cross-sectional analyses showed a negative association between PP and executive function (beta=-0.010; 95% CI -0.020 to -0.001; P=0.027; I2=66.8%; n=9,242). There was evidence of a negative association between PP and processing speed in cross-sectional analysis (beta=-0.001; P<0.001; n=5,828), with few longitudinal studies available. Inconsistent findings in studies for all domains were narratively summarised. Associations between PP and attention and visuospatial ability showed limited evidence. Conclusions: Meta-analysis suggests PP is positively associated with global cognition, whilst negatively associated with memory. Inconsistent findings or no association were reported for language, attention, executive function, processing speed and visuospatial ability, warranting further investigation by sufficiently powered longitudinal studies.
Gaunt et al. (Fri,) conducted a meta-analysis in Cognitive function. Pulse pressure was evaluated on Global cognition (cross-sectional) (beta 0.005, p=0.0218). Pulse pressure was positively associated with global cognition (beta 0.005; P=0.0218) but negatively associated with memory (beta -0.002; P<0.0042) in cross-sectional meta-analyses.