Journal Article 1 Mention
Visit‐to‐visit systolic blood pressure variability, blood pressure treatment intensity, and cognitive decline
Yue Qiao2026
Zihan SunXunming Ji
Few Citations
0 citations · Psychiatry and Mental health
Open AccessUsing genetics to better understand disease processes in cerebral small vessel disease and vascular cognitive impairment to improve treatment and prediction

TLDR

People whose blood pressure changes a lot from one doctor visit to the next tend to have faster memory and thinking problems over time, even if their average blood pressure is normal.

Summary

1 Study Aim

The study set out to determine whether fluctuations in systolic blood pressure (the top number in a blood pressure reading) from one clinic visit to another—known as blood pressure variability (BPV)—are linked to faster declines in thinking and memory skills, regardless of a person's average blood pressure. The researchers also wanted to see if this relationship changes depending on how aggressively blood pressure is treated in people with and without diabetes. Big swings in blood pressure from visit to visit might speed up memory and thinking problems, no matter what the average blood pressure is.

2 Study Design

The researchers combined data from two large clinical trials: SPRINT-MIND (which included people with high blood pressure but no diabetes) and ACCORD-MIND (which included people with type 2 diabetes). They analyzed information from 11,104 participants who had at least three blood pressure readings and repeated memory and thinking tests over about four years. Blood pressure variability was measured using several statistical methods, focusing on variation independent of mean (VIM), which captures how much blood pressure changes regardless of the average level. The main outcome was the yearly change in scores on a test that measures processing speed and attention (the Digit Symbol Substitution or Coding Test). The study looked at how changes in blood pressure from visit to visit relate to changes in thinking skills over time in people with and without diabetes.

3 Findings

The study reveals that higher visit-to-visit systolic blood pressure variability is linked to faster declines in cognitive performance, even after accounting for average blood pressure and other health factors. This relationship was consistent across different ways of measuring blood pressure variability and was especially noticeable in people receiving more intensive blood pressure treatment, though this pattern did not reach strong statistical significance. The effect was similar in both people with and without diabetes. The authors suggest that reducing blood pressure variability, not just lowering average blood pressure, could help protect thinking and memory skills in people at high risk for heart disease. They recommend future research to test if targeting blood pressure variability can slow cognitive decline. People whose blood pressure goes up and down a lot between doctor visits tend to lose thinking skills faster, so keeping blood pressure steady might help protect the brain.

Abstract

INTRODUCTION: Visit-to-visit blood pressure variability (BPV) may be associated with cognitive decline beyond mean blood pressure (BP), but its relevance across treatment contexts remains uncertain. METHODS: We pooled individual-participant data from Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) and Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND) (n = 11,104). Participants had baseline and follow-up cognitive testing and ≥3 BP measurements from 3 months onwards. The primary exposure was systolic BP variation independent of the mean (SBP-VIM). The primary outcome was annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores. RESULTS: Each 10% increment in SBP-VIM was independently associated with faster annual cognitive decline (β = -0.008 per year; 95% confidence interval [CI]: -0.014 to -0.003) after adjustment including mean SBP. Associations were observed in the intensive but not standard BP treatment arms of both trials, although the pooled interaction was not statistically significant (p = 0.054). DISCUSSION: Higher systolic BPV was associated with accelerated cognitive decline independently of mean BP. The exploratory treatment-context pattern warrants prospective confirmation.

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