Vascular risk factors contribute to the cognitive impairment in elderly patients with hypertension and cerebral small vessel disease: evidence from a retrospective analysis.

OBJECTIVES: Hypertension is a well-established risk factor for cerebral small vessel disease (CSVD) and cognitive impairment. However, the combined effects of demographic, clinical, and vascular factors on cognitive decline in elderly hypertensive patients with CSVD are not fully clarified. In the current study, we aimed to analyze clinical risk factors and cognitive profiles associated with hypertension-related CSVD in older adults. METHODS: We compared hypertensive patients with mild cognitive impairment (MCI), hypertensive patients without MCI, and normotensive controls in 351 cases. Baseline demographics, comorbidities, and medication history were assessed. Logistic regression models were constructed to identify the independent predictors of cognitive impairment. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and subgroup analyses stratified by age, sex, and dipping status. RESULTS: Patients with hypertension and MCI were older, more often female, and exhibited a higher prevalence of diabetes, dyslipidemia, and coronary artery disease compared with controls. Logistic regression identified advanced age, female sex, and non-dipping blood pressure profiles as independent predictors of MCI. The predictive model demonstrated good discrimination and calibration. Subgroup analyses revealed that advanced age, female sex, and nondipping blood pressure patterns were associated with higher cognitive impairment rates. CONCLUSIONS: Our findings suggest that traditional vascular risk factors contribute to cognitive decline in elderly hypertensive patients with CSVD. The proposed model provides a clinically useful tool for risk stratification and early intervention.