Association of Longitudinal Change in Ambulatory Blood Pressure With Cognitive Decline in Older Adults

Background There has been no study about the association of longitudinal change in ambulatory blood pressure (BP) variability and level with cognitive decline. Objectives The purpose of the study was to evaluate whether BP changes via ambulatory BP monitoring predict cognitive decline progression. Methods Twice-annual ambulatory BP readings were examined during 5 years and their relationship with changes in the Japanese version of the Montreal Cognitive Assessment (MoCA-J) scores. BP variability was assessed using SD, coefficient of variation, and average real variability (ARV). Cognitive decline, defined as a change in the MoCA-J score, was assessed, with the threshold set at the quartile showing the greatest decrease, which we categorized as cognitive dysfunction (-4 points or less). Results Among 206 participants (mean age 79.9 [+/- 7.5] years), baseline 24-hour systolic blood pressure (SBP)/diastolic blood pressure (DBP) averaged 115.2/67.0 mm Hg. Over 4.98 years (IQR: 4.94-5.04 years), MoCA-J scores showed a nonsignificant decline from 20.2 +/- 0.4 to 19.9 +/- 0.4. A generalized linear mixed model showed that increased SD of daytime SBP (-0.064 [95% CI: -0.121 to -0.007]; P < 0.029) and DBP (-0.125 [95% CI: -0.213 to -0.037]; P = 0.005) were significantly linked to MoCA-J score decline, with similar trends for most measures except nighttime ARV. Logistic regression revealed higher ORs for cognitive decline with increased SD of daytime SBP (1.52 [95% CI: 1.18-1.96]; P = 0.001) and DBP (1.36 [95% CI: 1.09-1.71]; P = 0.007), consistent across coefficient of variation and ARV. No association was found between changes in BP level and MoCA-J score decline. Conclusions In older adults with controlled BP, increased BP variability was linked to cognitive decline, warranting further study as a prevention target. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).