Evidence map›Paper›PMID 35112096›Full record

ArticleThe lancet. Healthy longevity2022

Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study.

Longjian Liu, Kathleen M Hayden, Nathalie S May, Bernhard Haring, Zuolu Liu, Victor W Henderson, Jiu-Chiuan Chen, Edward J Gracely, Sylvia Wassertheil-Smoller, Stephen R Rapp

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. Healthy longevity, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 3 pooled it
7.9field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.

  1. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  2. Management of brain-heart multimorbidity: a clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  3. Pooled it
  4. Trial
  5. Article
  6. Natriuretic Peptides as a Biomarker of Cognitive Decline in Hypertension.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026
    Review
  7. Article
  8. Article
  9. Article
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  12. Article
  13. Article
  14. Observational
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  17. Review
  18. Review
  19. Observational
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 3 countries.

Longjian LiuDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Kathleen M HaydenDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Nathalie S MayDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Bernhard HaringDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Zuolu LiuDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Victor W HendersonDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Jiu-Chiuan ChenDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Edward J GracelyDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Sylvia Wassertheil-SmollerDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Stephen R RappDepartment of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
Drexel University · USMedical University of Graz · ATSutter Health · USWake Forest University · US

Funding

Stanford Alzheimer's Disease Research CenterAdmin Supp: Developing iPSC models for AD and PDP30AG066515 · NIA · STANFORD UNIVERSITY · PI ELIZABETH MORMINO · 2020 to 2026
$29.0M
Stanford Medicine Center for Longevity and Healthy Aging Research Education CoreP30AG059307 · NIA · STANFORD UNIVERSITY · PI PERIYAKOIL, VYJEYANTHI S, YESAVAGE, JEROME A · 2018 to 2025
$4.9M
NHLBI NIH HHS HHSN268201600001CNHLBI NIH HHS HHSN268201600003CNHLBI NIH HHS HHSN268201600004CNHLBI NIH HHS HHSN268201600018CNIA NIH HHS HHSN271201100004CNIA NIH HHS P30 AG059307NIA NIH HHS P30 AG066515NIDA NIH HHS HHSN271201700002C
6 · The paper itself

Abstract

backgroundWhether blood pressure (BP), and at what level of controlled BP, reduces risk of cognitive impairment remains uncertain. We investigated the association of BP and hypertension treatment status with mild cognitive impairment and dementia in older women.

methodsWe prospectively analysed a sample of 7207 community-dwelling women aged 65-79 years participating in the Women's Health Initiative Memory Study (WHIMS). Participants were recruited between May 28, 1996, and Dec 13, 1999, at 39 US clinical centres, and they were followed up until Dec 31, 2019. Cognitive function was assessed annually. Mild cognitive impairment and probable dementia were defined through a centralised adjudication process. BP was measured by trained and certified staff at baseline. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Hypertension was defined using the American Heart Association 2017 Guideline for High BP in Adults. Outcomes were (1) mild cognitive impairment, (2) probable dementia, and (3) cognitive loss (the combined endpoint of either mild cognitive impairment or probable dementia, or both). We estimated hazard ratios (HRs) to assess the association between hypertension, SBP, and PP with the risk of study outcomes using Cox proportional hazards regression models, with adjustment for key covariates.

findingsDuring a median follow-up of 9 years (IQR 6-15), 1132 (15·7%) participants were classified as mild cognitive impairment, 739 (10·3%) as probable dementia, and 1533 (21·3%) as cognitive loss. The incidence rates per 1000 person-years were 15·3 cases (95% CI 14·4-16·2) for mild cognitive impairment, 9·7 cases (9·0-10·4) for probable dementia, and 20·3 (19·3-21·3) for cognitive loss. Elevated SBP and PP were significantly associated with increased risk of mild cognitive impairment and cognitive loss (test for trends across SBP and PP strata, p<0·01). Individuals with hypertension, but with controlled SBP of less than 120 mm Hg did not have a significantly increased risk of mild cognitive impairment (HR 1·33, 95% CI 0·98-1·82, p=0·071), and of cognitive loss (1·09, 0·82-1·44, p=0·57) compared with normotension. Individuals on anti-hypertensive treatment with PP of less than 50 mm Hg did not have a significantly higher risk of mild cognitive impairment (1·26, 0·98-1·62, p=0·07) and of cognitive loss (1·17, 0·94-1·46, p=0·16). There were no significant associations between hypertension, SBP, or PP and probable dementia.

interpretationResults of our study show significant associations of hypertension and elevated SBP and PP levels with risk of mild cognitive impairment and the combined endpoint of either mild cognitive impairment or probable dementia, suggesting that intensive control of hypertension, SBP, and PP can preserve cognitive health in older women.

fundingNational Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services.

Indexed as

Cognitive DysfunctionDementiaHypertensionAdultAgedBlood PressureFemaleHumansUnited StatesWomen's Health

Identifiers

PMID35112096
PMCPMC8804967
OpenAlexW4210430784

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.