Two new studies presented at the American College of Cardiology's 75th Annual Scientific Session in New Orleans suggest that measurements derived from routine blood pressure readings could help identify adults at heightened risk for dementia — findings that researchers say may reshape how clinicians think about hypertension management.
The research, being presented at the three-day cardiology conference taking place March 28–30 at the Ernest N. Morial Convention Center, examines how patterns of arterial stiffness tracked over time relate to the onset of dementia. Both studies analyzed data from 8,536 participants in the SPRINT trial — a large, multicenter study of adults aged 50 and older with hypertension — over a five-year follow-up period, during which 323 participants developed probable dementia.
The first study found that pulse pressure-heart rate index, a figure calculated from heart rate and blood pressure measurements, independently predicted dementia risk among adults over 50. Participants under 65 with a higher pulse pressure-heart rate index faced a significantly elevated risk: each unit increase in the index was associated with a 76 percent higher risk of developing probable dementia or mild cognitive impairment.
The second study focused on estimated pulse wave velocity — a marker of vascular aging calculated from age and blood pressure — and found that adults with persistently elevated or rapidly increasing velocity were significantly more likely to develop dementia than those with more stable vascular profiles. The association held even after researchers controlled for factors including age, sex, kidney disease, cardiovascular history and smoking.
"Blood pressure management isn't just about preventing heart attacks and strokes; it may also be one of the most actionable strategies for preserving cognitive health," said Newton Nyirenda, an epidemiologist at Georgetown University and lead author of both studies. "We need to start thinking about hypertension management much earlier than we typically have in order to address this in younger adults before damage starts to accumulate."
The clinical appeal of both metrics lies in their accessibility. Because pulse pressure-heart rate index and estimated pulse wave velocity are derived from data already collected during primary care visits, the researchers say risk scoring based on either measure could be incorporated into existing clinical workflows without significant additional burden.
The findings arrive against a backdrop of converging public health concerns. Nearly half of US adults have high blood pressure, a condition long associated with cardiovascular disease and increasingly linked to cognitive decline. Hypertension is very common in persons over the age of 50 and is a leading risk factor for heart disease, stroke, kidney failure, and a growing body of research suggests it may increase the risk for dementia later in life.
"Clinicians should focus on individualizing risk assessments and then tailoring treatment strategies that help patients improve cardiovascular health while preventing neurocognitive decline," said Sula Mazimba, an associate professor at the University of Virginia and senior author of the studies. "You don't want to wait until a patient starts manifesting cognitive decline before you act."
Researchers were careful to note the study's limitations. As a post hoc analysis of clinical trial data, the findings cannot establish causation. The participants were adults with hypertension and elevated cardiovascular risk, meaning results may not generalize to lower-risk populations. Further studies are needed to validate clinically actionable thresholds and to determine whether modifying vascular aging trajectories can meaningfully reduce dementia risk.
The full study, "Estimated Pulse Wave Velocity Trajectories and Risk of Incident Probable Dementia in SPRINT-MIND," is scheduled for presentation on Sunday, March 29.
