Background
•Hypertension (HTN) affects roughly half of U.S. middle-aged adults and is a well-established risk factor for Alzheimer's disease (AD).
•While midlife hypertension is associated with late-life cognitive decline, the relationship between blood pressure control and current midlife cognitive function remains understudied.
Research question: Are differences in blood pressure control status associated with cognitive performance differences in middle-aged primary care patients?
Setting and Sample:
•1079 participants from the Health Literacy and Cognitive Function Among Middle-Aged Adults (‘Midcog’) longitudinal cohort study, ages 35-64 and recruited from primary care clinics across Chicago, IL.
Measures:
Cognitive Measures
•NIH Toolbox (Version 3) tasks
•9 tasks: Dimensional Change Card Sorting (DCCS), Flanker Inhibitory Control and Attention, Visual Reasoning (VR), Face Name Associative Memory (F-name), List Sorting Working Memory (LSWM), Picture Sequencing Memory (PSM), and Pattern Comparison Processing Speed (PC), Oral Reading (ORR), and Vocabulary Reading (VR)
•Age- and education-adjusted T-scores calculated for each task and total, fluid, and crystallized cognition composites.
Blood Pressure Control Status Groups
Analysis:
•Bivariate: Compared NIH Toolbox tasks and cognition composites by BP control status groups; One-way ANOVA comparing T-scores across groups, with Tukey-adjusted pairwise comparisons
Results:
•Average age was 51.9 years (SD: 8.2); majority were female (59.3%), non-Hispanic Black (40.9%), and had a college degree (60.2%). Participants had an average of 2.1 chronic conditions (SD: 1.8) and 5.6 prescription medications (SD: 5.1).
•Relative to HC, uncontrolled HTN on medication was associated with lower total cognition, crystallized, fluid composite domains, and performance across all cognitive measures aside from pattern comparison (all p <0.01).
•Compared to well-controlled HTN on medication, uncontrolled HTN was associated with lower total cognition, crystallized cognition, oral reading, and picture vocabulary (all p <0.01).
•Unmedicated HTN showed modest differences in crystallized cognition, PV, and VR compared to HC (all p<0.05).
•No significant differences emerged between well-controlled HTN on medication and HC across cognitive outcomes.
Key findings: Uncontrolled HTN on medication showed the largest cognitive performance differences across all composites and individual domains compared to healthy controls. Well-controlled HTN was statistically indistinguishable from healthy controls.
Conclusions:
•Cognitive differences were most pronounced with uncontrolled HTN, regardless of medication status.
•Well-controlled HTN was associated with cognitive performance comparable to healthy controls, highlighting the importance of BP control rather than antihypertensive medication use alone.
•Findings support midlife BP control as a modifiable target for promoting cognitive health and reducing risk for cognitive decline.
Practice Implications:
•Focus on achieving BP control rather than medication use alone.
•Identify and intervene on uncontrolled and untreated hypertension during midlife.
•Midlife BP control may represent a modifiable target for preserving cognitive health and reducing later dementia risk.
