Trajectories of Cognitive Decline Before and After New-onset Hypertension

Background: Hypertension is a known factor for cognitive impairment, especially in midlife. However, whether the cognitive function declines before and shortly after new-onset hypertension remains largely unknown. Objectives: We aimed to examine the cognitive trajectories before and after new-onset hypertension among community-dwelling midlife and older participants. Methods: This study included 2,964 participants from the English Longitudinal Study of Ageing who were free of hypertension at baseline. Participants who had a stroke at baseline or during follow-up were excluded. Global cognition (a summary of semantic fluency, orientation, and memory) was assessed at baseline (wave 2, 2004) and at least once from wave 3 to wave 9 (2018). New-onset hypertension was defined by self-reported doctor diagnosis, use of antihypertensive medications, and blood measurements < 140/90 mmHg. Results: Over a median follow-up of 13.6 years, 1,121 (37.8%) participants developed hypertension. The cognitive decline rate among those who later developed hypertension during the pre-hypertension period was similar to the rate among those who remained hypertension-free throughout the study. After the onset of hypertension, the rate of cognitive decline accelerated in global cognition (β, -0.015 SD/year; 95% CI, -0.026 to -0.003; p=0.011), semantic fluency (β, -0.015 SD/year; 95% CI, -0.027 to -0.003; p=0.017), and memory (β, -0.022 SD/year; 95% CI, -0.033 to -0.010; p<0.001), but not in orientation ability (β, -0.012 SD/year; 95% CI, -0.028 to 0.005; p=0.157). Participants who developed hypertension in older age did not experience a reduced impact of post-hypertension cognitive decline compared to those who developed hypertension in midlife. Conclusions: Participants experienced accelerated cognitive decline upon developing new-onset hypertension. Older participants are equally susceptible to cognitive impairment due to hypertension. Early antihypertensive initiation is crucial in both midlife and later life to protect cognitive health.