Blood pressure variability, dementia, and role of antihypertensive medications in older adults

Alzheimers Dement. 2023 Jul;19(7):2966-2974. doi: 10.1002/alz.12935. Epub 2023 Jan 19.


Introduction: We assessed the association between visit-to-visit blood pressure variability (BPV) up to 12 years and subsequent dementia risk, and tested the modifying effect of antihypertensive medications.

Methods: We studied 2234 participants from two community-based cohorts of older adults with normal cognition or mild cognitive impairment. Participants were followed through annual assessments for up to 27 years. Visit-to-visit BPV was quantified over 3, 6, 9, and 12 years, respectively.

Results: Higher systolic BPV (SBPV) during 3, 6, 9, and 12 years was associated with a subsequent increased risk of dementia, with hazard ratios ranging from 1.02 (95% confidence interval [CI]: 1.01-1.04) to 1.10 (95% CI: 1.05-1.16). The association between SBPV and dementia risk was stronger among participants not taking calcium channel blockers (p-for interaction < 0.05).

Discussion: Among older adults, long-term exposure to higher visit-to-visit SBPV is associated with an increased risk of dementia later in life, and calcium channel blockers may modify this association.

Highlights: Among adults aged >65, higher systolic blood pressure variability spanning 3-12 years is associated with an increased risk of dementia later in life. Single blood pressure measurement or mean blood pressure levels does not seem to associate with dementia risk among older adults. The association between systolic blood pressure variability and dementia risk is stronger among those not taking calcium channel blocker medications.

Keywords: antihypertensive medication; blood pressure variability; calcium channel blockers; dementia; older adults.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology
  • Calcium Channel Blockers / pharmacology
  • Calcium Channel Blockers / therapeutic use
  • Cognitive Dysfunction* / drug therapy
  • Dementia* / drug therapy
  • Dementia* / epidemiology
  • Humans
  • Hypertension* / drug therapy


  • Antihypertensive Agents
  • Calcium Channel Blockers