Sex-Specific Associations Between Blood Pressure and Cognitive Decline

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Sex-Specific Associations Between Blood Pressure and Cognitive Decline

Faster declines in systolic blood pressure were associated with simultaneous declines in global and domain-specific cognition among older women, but not older men.Faster declines in systolic blood pressure are associated with faster simultaneous declines in cognition among older women, but not men, according to a study published in the Although changes in blood pressure (BP) and cognition are common with aging, the relationship between longitudinal changes in BP and cognitive function, particularly by sex, remains poorly understood.  Researchers therefore evaluated whether simultaneous changes in BP and cognition differed between older women and men using data from 5 ongoing longitudinal, community-based cohorts: Religious Orders Study (ROS)Rush University’s Memory and Aging Project (MAP) Minority Aging Research Study (MARS) Rush University’s Alzheimer’s Disease Center Clinical Core (ClinCore) Latino Core (LATC) Adults (N=4719) who underwent annual BP and cognitive assessments were evaluated for longitudinal changes in both. The women (n=3502) and men (n=1217) had a mean (SD) age of 76.7 (7.8) and 76.8 (7.5) years, respectively. Among women and men, 62.9% and 70.3% were White, respectively; mean (SD) BMI was 28.3 (5.9) and 27.93 (4.3) kg/m², and 58.1% and 50.1% had a history of hypertension, respectively.Understanding these sex-specific associations may help advance the understanding of drivers behind sex differences in cognitive decline. Over a mean (SD) 8.7 (5.7)-year follow-up, systolic BP, diastolic BP, global cognition, working memory, semantic memory, episodic memory, perceptual speed, and visuospatial ability all declined significantly (all P <.01). Men experienced a greater decline in diastolic BP than women (adjusted estimate, −0.031 vs −0.011; P <.001), whereas no sex differences were observed in rates of decline for systolic BP or cognitive measures. Among women, higher systolic BP at baseline was significantly correlated with lower semantic memory, perceptual speed, and visuospatial ability scores (r range, −0.07 to −0.05; all P ≤.04). Faster declines in systolic BP over time were correlated with faster declines in global cognition and all 5 cognitive domains (r range, 0.20-0.32; all P <.001).

Diastolic BP was correlated with global cognition, working memory, and visuospatial ability among women (r range, -0.06 to -0.05; all P ≤.03), whereas changes in diastolic BP were not correlated with changes in any cognitive outcomes (all P ≥.35).

Among men, higher systolic BP at baseline was significantly correlated with lower global cognition, perceptual speed, and visuospatial ability (all r, −0.08; all P ≤.04). Changes in systolic BP were not correlated with changes in any cognitive outcomes (all P ≥.23).

Diastolic BP was correlated with global cognition, episodic memory, and perceptual speed among men (r range, -0.11 to -0.10; all P <.01), while increasing diastolic BP was correlated with faster declines in working memory (r, −0.18; P =.03).

Sensitivity analyses showed that the associations between changes in BP and cognition were robust after adjustment for BMI, race/ethnicity, apolipoprotein E (APOE) ε4 status, study cohort, and number of follow-up visits. Excluding participants who developed dementia within 3 years of baseline and adjusting for death during follow-up also did not alter the findings.

In age-stratified analyses, the relationships between changes in BP and cognition were primarily observed later in life. Among participants older than 70 years, associations between declining systolic BP and global and domain-specific cognition were comparable to or larger than those in the primary analyses. Among participants aged 70 years and younger, these relationships were attenuated.

Study limitations included the predominantly White study population, the inability to determine whether declining BP precedes cognitive decline or vice versa, the lack of data on hypertension control, and the possibility that a floor effect in cognitive scores among men contributed to the observed sex differences.

“As women experience a disproportionate burden of both hypertension and cognitive decline in late-life, declining systolic BP, a routine clinical measure, may serve as an important indicator of concurrent cognitive decline in older women,” the researchers concluded. They continued, “Understanding these sex-specific associations may help advance the understanding of drivers behind sex differences in cognitive decline.”

References:

Baumgartner NW, Capuano AW, Barnes LL, Bennett DA, Arvanitakis Z. Sex differences in the association of simultaneous decline in blood pressure and decline in cognition during aging. Ann Neurol. Published online July 7, 2026. doi:10.1002/ana.78280