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
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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.