Nonlinear relationship between pulse pressure and risk of cognitive impairment: A 4-year community-based cohort study in Xi?an, China

Objectives: It has been known that pulse pressure (PP) is a risk factor for cardiovascular disease and stroke, however, the relationship between PP and cognitive impairment is unclear.Methods: This was a community-based cohort study. Participates were followed-up for 4 years and new-onset cognitive impairment was diagnosed. Multivariable logistic regression and restricted cubic spline (RCS) were used to investigate the relationship between PP and cognitive impairment. Propensity score matching (PSM) and sensitivity analysis among ApoE epsilon 4 non-carriers were performed to confirm the results.Results: 1462 participants were included at baseline and 1173 completed the follow-up. There were 42 (3.5%) new-onset cognitive impairment of whom 31 were diagnosed with MCI and 11 with dementia during the follow-up. Multivariable logistic regression analysis showed that PP was positively associated with cognitive impair-ment (OR = 2.853, 95% CI 1.079-7.548, p = 0.035), and RCS suggested a non-linear relationship (Pnon-linear = 0.034). The risk of cognitive impairment merely changed when the PP was below about 46.7 mmHg and increased rapidly thereafter. After the covariates were well balanced using PSM (standardized mean differences <0.1 for all covariates), logistic regression analysis revealed the risk of cognitive impairment was still higher for those with high PP (OR = 3.369, 95% CI 1.202-9.441, p = 0.021). Sensitivity analysis showed consistent results with primary analysis.Conclusion: PP is associated with cognitive impairment in a non-linear manner among middle-aged and elderly. The risk of cognitive impairment increases rapidly when PP exceeds about 46.7 mmHg, which may be infor-mative for subsequent research of PP control ranges.