Variations in the Effect of Pulse Pressure on Cognition Based on Blood Pressure.

Background: An increase in pulse pressure, the difference between systolic and diastolic blood pressure, has emerged as a predictor of cognitive impairment in older adults. However, its predictive utility relative to blood pressure status and potential differential effects based on blood pressure status remain unclear. Methods: This study used data from the ACTIVE trial (N = 2,802 adults aged 65+) to examine the association between pulse pressure and cognitive decline over 10 years. Linear mixed-effects models assessed the relationship between pulse pressure, blood pressure, and decline in global cognition, memory, reasoning, and processing speed. Results: Higher pulse pressure was associated with faster global cognitive decline ( b = -0.003, 95% CI [-0.004, -0.001]) after controlling for demographics, cognitive training status, and attrition. This effect was consistent for the memory and reasoning domains. The effects remained significant after adjusting for blood pressure status, with pulse pressure demonstrating complementary predictive utility to blood pressure. Specifically, the negative effect of pulse pressure on global cognitive decline was observed only among participants with elevated blood pressure ( b = -0.005, 95% CI [-0.005, -0.002]), not in those with normal blood pressure. This pattern was consistent across the three cognitive domains. Conclusions: Pulse pressure is associated with accelerated cognitive decline among older adults, but this relationship is moderated by blood pressure status. Pulse pressure monitoring could improve cognitive risk assessment in older adults with elevated blood pressure. This underscores the importance of managing blood pressure to mitigate the risk of cognitive decline associated with increased pulse pressure.