ArticleBMC neurology2026
Interactive effects of vitamin D status and visit-to-visit systolic blood pressure variability on 12-month cognition and mild cognitive impairment in older adults with hypertension.
Article in BMC neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVisit-to-visit systolic blood pressure variability (BPV) has been linked to cognitive decline, but inter-individual susceptibility may depend on modifiable factors such as vitamin D status. We investigated whether baseline serum 25-hydroxyvitamin D [25(OH)D] modifies the association between systolic BPV and 12-month cognition among older adults with hypertension.
methodsIn this single-center prospective cohort, participants were recruited from May 2023 to June 2024 and followed for 12 months, adults aged ≥ 65 years with hypertension underwent baseline 25(OH)D measurement and Montreal Cognitive Assessment (MoCA) at baseline and Month 12. BPV was calculated from clinic SBP values during Months 0-10 (≥ 6 visits required). Average real variability of SBP (ARV-SBP) was the primary BPV metric; standard deviation (SD-SBP), coefficient of variation (CV-SBP), variability independent of mean (VIM-SBP), and range-SBP were examined in sensitivity analyses. Average real variability of SBP (ARV-SBP) was the primary BPV metric. The primary analysis used ANCOVA-style multivariable linear regression for Month 12 MoCA including ARV-SBP (per 1 SD), 25(OH)D (per 10 ng/mL, centered), and their interaction, adjusting for baseline MoCA and prespecified covariates. A screening-based, algorithm-defined MCI status at Month 12 was analyzed using modified Poisson regression with robust standard errors.
resultsAmong 176 participants (mean age 73.1 years), 73 (41.5%) had low vitamin D status [25(OH)D < 20 ng/mL] and 48 (27.3%) met algorithm-defined MCI status at Month 12. Higher ARV-SBP was associated with lower Month 12 MoCA (β=-0.22, 95% CI - 0.37 to - 0.07 β), and 25(OH)D significantly modified this association (interaction β = 0.18, 95% CI 0.05 to 0.32; p = 0.01 β), indicating attenuation of BPV-related cognitive disadvantage at higher vitamin D levels. The interaction remained directionally consistent across SD-SBP, CV-SBP, VIM-SBP, and range-SBP sensitivity models (all nominal p ≤ 0.04 ; FDR q ≤ 0.04 ). In joint-exposure analysis, low vitamin D status plus high BPV was associated with a higher probability of meeting algorithm-defined MCI status versus 25(OH)D ≥ 20 ng/mL with low BPV (adjusted RR = 4.14, 95% CI 1.93 to 8.90), while additive interaction was suggestive but imprecise (RERI = 1.94, 95% CI - 0.10 to 6.03).
conclusionsBaseline 25(OH)D was associated with heterogeneity in the observed association between clinic visit-to-visit systolic BPV and 12-month cognition in adults aged ≥ 65 years with hypertension. These findings support attention to BP stability and low vitamin D status as a potential marker of cognitive vulnerability in older hypertensive outpatients, while causal inference and supplementation effects require confirmation.
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