Abstract

INTRODUCTIONVascular disorders in midlife increase the risk for late‐life cognitive dysfunction and dementia.1–7 In the Multi‐Ethnic Study of Atherosclerosis (MESA), we have shown previously that higher baseline blood pressure (BP) and its change over time are associated with poorer performance on tests of global cognitive performance, processing speed, and working memory.4Blood pressure (or BP) can fluctuate across examinations in response to intrinsic regulatory mechanisms and extrinsic environmental and behavioral factors like poor drug adherence, uncontrolled hypertension, and aging.8,9 High blood pressure variability (BPV) has been explored as a risk factor for cognitive impairment.10–13 The Atherosclerosis in Communities (ARIC) study13 demonstrated that higher long‐term systolic BP (SBP) and diastolic BP (DBP) variability is associated with lower global cognition in later life, but not with cognitive decline, whereas the China Health and Nutrition Survey12 observed an association between high BPV and increased global cognitive decline. BPV has been associated with impaired cognitive function across domains and with adverse neurophysiological changes, such as tau accumulation, white matter lesions, and decreased hippocampal volume.10,11,14–16 BP control interventions have shown promise in reducing the risk of mild cognitive impairment (MCI) and incident dementia, but have typically been focused on lowering BP levels rather than BPV.17,18There