Gender and racial differences in the relationship between mean arterial pressure, pulse pressure, and cognitive function in older adults: NHANES 2011 to 2014.

The impacts of mean arterial pressure (MAP) and pulse pressure (PP) on cognitive decline have not been fully characterized, and little is known about the gender and racial differences in this relationship. This study aimed to look into the above-mentioned relationship. Information was obtained from the National Health and Nutrition Examination Survey 2011 to 2014. The Consortium to Establish a Registry for Alzheimer's Disease Word Learning Test (CERAD W-L), the Animal Fluency Test, and the Digit Symbol Substitution Test (DSST) were used to assess cognitive functioning in participants aged 60 years and older. Weighted linear regression analyses were employed to detect the relationship between MAP, PP (continuous or quartiles), and 3 cognitive test scores. Additionally, forest maps and smooth curve fitting were utilized to demonstrate subgroup analyses stratified by gender and race. There were 2612 participants in this study. After fully adjusting for covariates, MAP was negatively correlated with cognitive functioning estimated by CERAD W-L (β: -0.026, 95% confidence interval [CI]: -0.045 to -0.008), and PP was negatively associated with cognitive test scores through DSST (β: -0.039, 95% CI: -0.065 to -0.013). This tendency remained statistically significant across different MAP quartile groups and PP quartile groups (P for trend < .01). In the CERAD W-L test, subgroup analyses stratified by race as well as sex revealed that the negative relationship between MAP, PP, and cognitive scores remained significant in females (MAP: β: -0.042, 95% CI: -0.066 to -0.017; PP: β: -0.018, 95% CI: -0.033 to -0.002) and non-Hispanic White (NHW; MAP: β: -0.031, 95% CI: -0.052 to -0.010; PP: β: -0.016, 95% CI: -0.029 to -0.002). Additionally, a negative relationship between PP and cognitive scores was also found in DSST in females (β: -0.044, 95% CI: -0.077 to -0.011) and NHW (β: -0.041, 95% CI: -0.070 to -0.012). Our study suggested that elevated levels of MAP and PP were negatively correlated with cognitive functioning, particularly in females and NHWs. Therefore, the management of MAP and PP might be helpful for the prevention of poor cognitive performance in the elders. However, the cross-sectional nature of this study limits causal inference.