Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Judith Lichtman


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.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025