Following new hypertension onset, cognitive function more rapidly declines, especially in older individuals.
Cognitive function is reduced more rapidly after new-onset hypertension compared with before hypertension onset, and older individuals have faster cognitive decline before and after hypertension onset, according to a study in the Journal of the American Heart Association.
Researchers analyzed data from waves 2 to 9 of the English Longitudinal Study of Aging (ELSA). A total of 2964 participants free of hypertension at baseline were enrolled.
Self-reported, doctor-diagnosed hypertension and antihypertensive medication use were recorded in each wave. Cognitive function was assessed for semantic fluency, orientation, and memory. A global cognition z score was developed to summarize results of the 3 cognitive tests.
The median follow-up was 13.8 years for the hypertension group and 12.2 years for the hypertension-free group. Among the cohort, 1121 participants (37.8%) developed hypertension (mean age, 62.8±8.2 years; 43% men), and 1843 were without hypertension (mean age, 62.4±9.3 years; 42% men). Hypertension occurred after a mean of 4.6 (SD, 3.2) years.
Management of blood pressure is crucial in both midlife and later life to protect cognitive health.
Global cognition scores decreased at 0.023 SD per year (β, -0.023 SD/y; 95% CI, -0.027 to -0.018; P <.001) in the hypertension-free group. After onset of hypertension, the decreased rate of global cognition scores was significantly faster compared with the reduction rate before hypertension (β, -0.019 SD/y; 95% CI, -0.033 to -0.005; P =.007), which was twice the rate of normal aging (percentage increase, 83%; 95% CI, 52%-113%).
After the onset of hypertension, semantic fluency test scores (β, -0.015 SD/y; 95% CI, -0.027 to -0.003; P =.017) and memory test (β, -0.022 SD/y; 95% CI, -0.033 to -0.010; P <.001) were reduced more rapidly. The rate of reduction in orientation scores did not change significantly (β, -0.012 SD/y; 95% CI, -0.028 to 0.005; P =.157).
Individuals who developed hypertension between ages 65 and 74 years had a stronger reduction in global cognition after hypertension compared with those who had hypertension between ages 55 and 64 years (β, -0.046 SD/y; 95% CI, -0.077 to -0.014; P =.004).
Individuals aged 75 to 84 years had a steeper global cognitive decrease before (β, -0.029 SD/y; 95% CI, -0.058 to 0.000; P =.047) and after (β, -0.061 SD/y; 95% CI, -0.101 to -0.021; P =.003) hypertension. An older baseline age (70-99 vs 50-59 years) was associated with a steeper cognitive decrease in orientation (P for interaction =.002) and global cognition scores (P for interaction =.005).
In a sensitivity analysis, in a comparison of the mean cognitive slope from baseline to the end of follow-up between the hypertension group and the hypertension-free group, the hypertension group had increased baseline scores for all cognitive domains (global cognition; 0.101 SD; 95% CI, 0.046-0.166; P =.022).
Among several study limitations, ELSA did not include tests such as the Mini-Mental State Examination and Clinical Dementia Rating Scale, and the orientation score is a discrete dependent variable with a limited range. Also, potential covariates were unavailable, including ApoE4 status.
"Management of blood pressure is crucial in both midlife and later life to protect cognitive health," the study authors wrote.
References:
Chen Q, Dong J, Chen G-C, Li H, Shen Y, Hua J. Trajectories of cognitive decline before and after new-onset hypertension. J Am Heart Assoc. Published online June 5, 2025. doi: 10.1161/JAHA.124.039849
【全文结束】
