Racial Differences in the Relationship Between Blood Pressure and Cognitive Decline

BackgroundCognition may be influenced by health-related factors such as blood pressure (BP). However, variations in BP may differentially affect cognition as a function of race. This study investigates the relationship between normal, high, and variable BP and cognitive decline in older Black and White adults. Methods2284 participants (1139 Blacks, 1145 Whites, MAge=73.4, SD=6.6) from 3 harmonized cohorts of older adults from the Rush Alzheimers Disease Center, were divided into 3 groups (normal, high, variable) based on systolic BP mean and standard deviation. Cognitive scores were computed from multiple assessments in 5 domains (i.e., episodic memory, semantic memory, working memory, processing speed, visuospatial ability). Performance across 19 tests were averaged to create a measure of global cognition. Linear mixed-effects models examined racial differences between BP and cognitive change over an average of 6.7 years. ResultsWhite adults with high or variable BP had faster rates of decline in global cognition compared to Black adults. White adults with high BP declined faster in perceptual speed, semantic memory, and working memory compared to Black adults with high BP, whereas White adults with variable BP had faster rates of decline in all cognitive domains compared to Black adults with variable BP. No racial differences were observed in individuals with normal BP. ConclusionsWhite older adults with elevated or fluctuating BP show faster rates of cognitive decline compared to older Black adults. Findings highlight the complex interplay between BP and cognitive health, emphasizing the need for targeted interventions to address racial disparities in cognitive well-being.