# Associations of Blood Pressure Parameters with Cognitive Decline and Dementia: A Systematic Review of Reviews

## TL;DR

This review summarizes how different blood pressure factors relate to cognitive decline and dementia, highlighting the need for standardized definitions.

## Contribution

The study provides a comprehensive umbrella review of existing systematic reviews on blood pressure and cognitive outcomes.

## Key findings

- Higher mid-life blood pressure is linked to increased dementia risk.
- Blood pressure variability and pulse wave velocity are associated with cognitive decline.
- Most reviews had low quality and inconsistent definitions of blood pressure parameters.

## Abstract

Evidence syntheses on the associations between BP parameters and cognitive decline and/or dementia have taken different methodological approaches and targeted different BP parameters and outcomes. The aim of this umbrella review was to provide a high-level synthesis of published systematic reviews with meta-analyses on these associations.

PubMed, Embase, PsycINFO, and Cochrane were searched up to April 2025 for eligible reviews. Risk of bias was assessed using the AMSTAR-2 tool, and overlap of constituent studies between reviews was explored.

Among 31 included reviews, 8 reported positive associations between higher BP and greater incidence of cognitive decline or dementia, 5 drew neutral conclusions, and 1 reported an inverse relationship. Greater mid-life BP was associated with greater risk of all-cause dementia, whereas late-life hypertension might have a mixed or overall neutral association. Three reviews reported associations between higher BP variability and all-cause dementia, and 2 for cognitive decline. Reviews also reported associations between higher pulse wave velocity and orthostatic hypotension and poorer outcomes. No reviews examined PP, mean-arterial pressure, or cumulative BP load. Most reviews were of low quality, with considerable heterogeneity in BP parameter definitions and outcome criteria. Overlap of constituent studies for each BP parameter was low.

In addition to high BP, incorporating variability, pulse wave velocity and orthostatic hypertension into risk assessments of cognitive decline or dementia and adopting standardized definitions for BP parameters and cognitive outcomes may improve comparability across future studies and strengthen clinical guidance.

Graphical Abstract