Sex Differences in Blood Pressure and Cognitive Aging: National Alzheimer’s Coordinating Center (NACC_

TL;DR

The study found that blood pressure changes over time are linked to cognitive decline in Latino adults, with differences between men and women.

Contribution

The study reveals sex-specific associations between diastolic blood pressure and cognitive decline in Latino adults.

Findings

Higher diastolic blood pressure predicted steeper cognitive decline in women but was slightly protective in men.

Pulse pressure was linked to global cognitive decline in both sexes.

Long-term blood pressure monitoring is important for identifying cognitive decline risks in Latino populations.

Abstract

Elevated blood pressure (BP) is a known risk factor for cognitive decline that fluctuates over time, yet most studies rely on single or few BP measures and do not examine potential sex differences. Therefore, we investigated the associations between longitudinal BP and cognitive aging trajectories in Latino adults.

Participants included 800 Latino adults without dementia from the NACC (2015–2022, 28 sites) with an average of 7-years of repeated BP assessments. Mixed-effects regression models evaluated the effects of time-varying systolic (SYS), diastolic (DIAS), and pulse pressure (PP) on trajectories of global cognition, executive functioning, episodic memory, and language. Models sequentially adjusted for demographics (age, education, language, heritage, cognitive status) and health variables (time-varying BMI, baseline hypertension).

A significant DIAS × Age × Sex interaction emerged for executive functioning (β = 0.41, SE = 0.18, p = 0.02). Among females, higher diastolic BP predicted steeper age-related decline (slope=-0.06, p = 0.01), whereas in males the effect was attenuated and slightly protective (slope = +0.02, p = 0.04). For global cognition, higher PP predicted greater decline across both sexes (β=-0.36, SE = 0.13, p = 0.01). No other significant effects were observed.

Over 7-years of follow-up, diastolic BP had sex-specific associations with executive functioning trajectories, while PP broadly predicted global cognitive decline regardless of sex. These findings highlight that ongoing BP monitoring and consideration of sex-specific risks are essential for identifying Latino individuals who are at risk of cognitive decline.