Abstract
This study aimed to investigate the effects of pulse pressure (PP) on cognition and the role of white matter lesions (WMLs) in mediating this association. We enrolled 3,009 participants from the SPRINT-MIND study. Of those, 755 participants underwent brain magnetic resonance imaging. Cognitive tests were summarized in five cognition domains, including global cognition, executive function, attention, memory, and language. Multiple linear regression models were employed to analyze PP in association with cognition, and mediation analysis was applied to determine the role of WMLs in the association between PP and cognition. We found that PP was negatively linearly associated with global cognition (β = −0.048, P = 0.008), executive function (β = −0.014, P = 0.040), attention (β = −0.013, P = 0.035), memory (β = −0.021, P = 0.045), and language (β = −0.020, P = 0.001), respectively. Furthermore, PP was not significantly associated with brain component volume changes, except for WMLs (β = 0.029, P = 0.044). Additionally, mediation analysis showed that increased WML volume contributed to 10.8% of global cognition, 9.5% of executive function, 10.6% of memory, and 7.2% of language decline associated with PP. Exposure to higher PP levels was associated with poor cognitive performance, and WMLs partially moderated the influence of PP on cognition.
Highlights
Most previous studies have shown that elevated blood pressure (BP) exacerbates cognitive impairment [1,2,3]
SPRINT was a multicenter, randomized controlled trial that examined whether intensive BP treatment (SBP < 120 mm Hg) would reduce the risk of cardiovascular events and total mortality compared with standard BP treatment (SBP < 140 mm Hg) among 9,361 participants aged ≥50 years with hypertension (SBP of 130 to 180 mm Hg)
We examined the association between pulse pressure (PP) and cognition involving a subset of 755 participants who had undergone brain MRI
Summary
Most previous studies have shown that elevated blood pressure (BP) exacerbates cognitive impairment [1,2,3]. The role of elevated pulse pressure (PP) in the cognitive decline process needs to be investigated. The association between PP and cognition remains controversial. A community-based longitudinal study is the first to demonstrate that higher PP is associated with increased risk for Alzheimer’s disease and dementia [4]. A secondary analysis of the hypertension in the very elderly trial (HYVET) indicated that wider PP may increase the risk of dementia [5]. A few studies suggested that higher PP is not independently associated with cognitive decline [9, 10]
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