| Sumario: | Objectives This study examined the predictive utility of pulse pressure relative to blood pressure status for cognition among older adults and the potential differential effects of pulse pressure on cognition based on blood pressure status. Methods We used data from the ACTIVE trial (N = 2,802 adults aged 65 years and older) to examine the association between pulse pressure and cognitive decline over 10 years. Linear mixed-effects models assessed the relationship between pulse pressure, blood pressure, and decline in global cognition, memory, reasoning, and processing speed. Results Among 2,787 older adults (mean age 73.65, 24.15% male, 73.31% White), higher pulse pressure was associated with faster global cognitive decline (b = −0.003, 95% CI [−0.004, −0.001]) after controlling for demographics, cognitive training status, and attrition. This effect was consistent acrossr the memory and reasoning domains. The effects remained significant after adjusting for blood pressure status, with pulse pressure demonstrating complementary predictive utility beyond blood pressure. Specifically, the negative effect of pulse pressure on global cognitive decline was observed only among participants with elevated blood pressure (b = −0.005, 95% CI [−0.005, −0.002]), not in those with normal blood pressure. This pattern was consistent across all three cognitive domains. Discussion Pulse pressure is associated with accelerated cognitive decline among older adults, but this relationship is potentially moderated by blood pressure status. Pulse pressure monitoring could improve cognitive risk assessment in older adults with elevated blood pressure. This underscores the importance of managing blood pressure to mitigate the risk of cognitive decline associated with increased pulse pressure.
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