Date of Award

1-1-2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Judith Lichtman

Abstract

Objectives: This study aimed to examine the cross-sectional, longitudinal associations and trajectories between cognitive decline and blood pressure (BP) categories defined by the 2017 American College of Cardiology/American Heart Association guideline and to explore sex differences in cognitive decline trajectories in each BP category.Design, setting, and participants: The Atherosclerosis Risk in Communities study is a longitudinal cohort study (1987-2018). 10,456 of 15,792 participants (female 55.5%) were included in the analysis with a median follow-up time of 22.2 years. Exposures: Blood pressure (BP) was measured at 6 of the study visits and was categorized as normal BP (Systolic BP [SBP] < 120 and Diastolic BP [DBP] < 80 mmHg; n = 930), elevated BP (SBP 120-129 and DBP < 80mmHg; n = 853), hypertension stage 1 (SBP 130-139 mmHg, or DBP 80-89 mmHg; n = 1,142), and hypertension stage 2 (SBP >=140 mmHg, or DBP >=90 mmHg, or participants taking antihypertensive medication; n = 7,531). Main outcomes and measures: The primary outcome was change in the cognitive score over time. Cognitive function in memory, executive function, and language domain was assessed using a battery of standardized tests. Baseline (visit 2) and most recent cognitive assessment were included in the analysis. Results: Participants with stage 2 hypertension showed the fastest decline per year in executive function (-0.401, 95% CI: -0.409, -0.392), language (-0.109, 95% CI: -0.120, -0.099), and global cognition (-0.335, 95%: -0.344, -0.326). Females across all BP categories experienced a significantly faster decline in executive function per year than males, with the greatest difference in elevated BP (-0.071, 95% CI: -0.071, -0.073). Conclusions: Participants with stage 2 hypertension experience the fastest decline rate in cognition. Women have a faster decline rate in the executive function domain in all BP categories than men.

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