Journal article
Late-life, visit-to-visit blood pressure variability and its association with sex-specific long-term cognitive outcomes
Journal of human hypertension, Vol.39(12), pp.831-840
12/2025
DOI: 10.1038/s41371-025-01087-5
PMCID: PMC12685738
PMID: 41109864
Appears in UI Libraries Support Open Access
Abstract
In 19 114 community-dwelling older adults enrolled in the ASPREE trial, high late-life visit-to-visit blood pressure variability (BPV) was associated with increased risks of incident dementia and cognitive decline during the median 4.7 year trial period. Whether sex or apolipoprotein E (ApoE) affect these associations over longer-term follow-up is unknown. We investigated the association between BPV and long term risks of dementia and cognitive decline using data from the ASPREE-eXTension (ASPREE-XT) study (median 8.3 year follow-up for dementia, 7.3 years for cognitive decline, after BPV estimation). Long-term BPV was estimated using standard deviation (SD) of the mean systolic BPs measured at ASPREE baseline, year 1 and 2 visits. Incident dementia was an adjudicated secondary endpoint and cognitive decline was defined as ≥1.5 SD decline in score from baseline sustained on the same of one, or more, standardized cognitive tests administered annually/biennially throughout ASPREE/ASPREE-XT. Analyses were stratified a priori by sex, using sex-specific SD tertiles of systolic BPV. Multivariable Cox proportional hazards regression comparing the highest BPV tertile to the lowest showed increased risk of dementia (HR = 1.33, 1.10-1.61) and cognitive decline (HR = 1.17, 1.06-1.30) in males, and cognitive decline in females (HR = 1.17, 1.07-1.28). In ApoE genotyped participants (81%), females in the highest BPV tertile lacking the ɛ4 allele had increased risk of dementia (HR = 1.39; 1.04-1.84), while risk of cognitive decline was increased in both sexes lacking the ɛ4 allele (males HR = 1.25; 1.09-1.43; females HR = 1.14; 1.01-1.29). These findings suggest both sex and ApoE impact the association of high BPV with long-term cognitive changes.
Details
- Title: Subtitle
- Late-life, visit-to-visit blood pressure variability and its association with sex-specific long-term cognitive outcomes
- Creators
- Michael E Ernst - University of IowaKerry M Sheets - Hennepin Healthcare Research InstituteKatherine L Webb - Monash UniversityMichelle A Fravel - University of IowaRobyn L Woods - Monash UniversityLawrence Beilin - The University of Western AustraliaSuzanne G Orchard - Monash UniversityRaj C Shah - Rush University Medical CenterKevan R Polkinghorne - Monash UniversityChristopher M Reid - Monash UniversityRory Wolfe - Monash UniversityAnne Murray - Berman Center for Outcomes and Clinical ResearchPaul Lacaze - Monash UniversityJoanne Ryan - Monash University
- Resource Type
- Journal article
- Publication Details
- Journal of human hypertension, Vol.39(12), pp.831-840
- DOI
- 10.1038/s41371-025-01087-5
- PMID
- 41109864
- PMCID
- PMC12685738
- NLM abbreviation
- J Hum Hypertens
- ISSN
- 1476-5527
- eISSN
- 1476-5527
- Publisher
- Springer Nature
- Grant note
- 1127060 / Department of Health | National Health and Medical Research Council (NHMRC) U01AG029824 / U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging) U19AG062682 / U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging) 334037 / Department of Health | National Health and Medical Research Council (NHMRC)
- Language
- English
- Electronic publication date
- 10/18/2025
- Date published
- 12/2025
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9985016015802771
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