Abstract 13062: Association Between Blood Pressure Levels and Cognitive Decline in Community-Dwelling Older Adults: A Prospective Analysis of the China Health and Retirement Longitudinal Study

Background: The association between blood pressure (BP) and the risk of cognitive impairment in older adults is limited. It is unclear at which thresholds BP increases the risk of cognitive decline. We aimed to investigate the association between BP and hypertension treatment status with cognitive decline in older adults. Methods: This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into five groups according to their visit measures of BP: 1) BP <120/80 mm Hg; 2) systolic BP (SBP) 120-129 mm Hg and diastolic BP (DBP) <80 mmHg; 3) BP ≥130/80 and <140/90 mmHg; 4) BP ≥ 140/90 mmHg; 5) and participants with anti-hypertensive medication treatment regardless of their BP levels. The global cognitive Z score was calculated as the average score of episodic memory and mental intactness. Linear mixed models were used to assess the longitudinal association between the BP group, SBP, pulse pressure (PP), and cognitive decline. Results: A total of 11,671 participants from CHARLS were included (47.3% men and mean age 58.6 ± 9.0 years). After adjusting for potential confounders, participants with BP ≥ 140/90 mm Hg but no anti-hypertensive medication were independently associated with accelerated cognitive decline ( β = -0.020, 95% CI -0.028 to -0.012; P <0.001). This trend was not significant for participants on anti-hypertensive treatment regardless of their BP levels. Elevated SBP and PP were found to be independently associated with accelerated cognitive decline ( P < 0.001 for both). However, participants on anti-hypertensive treatment for pre-existing hypertension, but with controlled SBP < 140 mm Hg and PP < 70 mm Hg did not have a significantly increased risk of cognitive decline. Conclusions: Uncontrolled hypertension was associated with subsequent cognitive decline. Effectively controlling BP with anti-hypertensive treatment can preserve cognitive health in older adults.