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A non-linear relationship between blood pressure and mild cognitive impairment in elderly individuals: A cohort study based on the Chinese longitudinal healthy longevity survey (CLHLS)

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Abstract

Background

Hypertension is an established risk factor for mild cognitive impairment (MCI) in elderly individuals. Nevertheless, the impact of different levels of blood pressure on the progression of MCI remains uncertain. This study aims to investigate the non-linear relationship between blood pressure and MCI in the elderly and detect the critical blood pressure threshold, thus, improving blood pressure management for individuals at high risk of MCI.

Methods

Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort. We chose normal cognitive elderly individuals who entered the cohort in 2014 for a 5-year follow-up to observe the progression of MCI. Subsequently, we utilized the Cox regression model to identify risk factors for MCI and conducted a Cox-based restricted cubic spline regression (RCS) model to examine the non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with MCI, determining the critical blood pressure threshold for MCI progression.

Results

In the elderly population, female (HR = 1.489, 95% CI: 1.017–2.180), lacking of exercise in the past (HR = 1.714, 95% CI: 1.108–2.653), preferring animal fats (HR = 2.340, 95% CI: 1.348–4.061), increased age (HR = 1.061, 95% CI: 1.038–1.084), increased SBP (HR = 1.036, 95% CI: 1.024–1.048), and increased DBP (HR = 1.056, 95% CI: 1.031–1.081) were associated with MCI progression. After adjusting factors such as gender, exercise, preferred types of fats, and age, both SBP (P non-linear < 0.001) and DBP (P non-linear < 0.001) in elderly individuals exhibited a non-linear association with MCI. The risk of MCI rose when SBP exceeded 135 mmHg and DBP was in the range of 80–88 mmHg. However, when DBP exceeded 88 mmHg, there was a declining trend in MCI progression, although the HR remained above 1. The identified critical blood pressure management threshold for MCI was 135/80 mmHg.

Conclusion

In this study, we discovered that risk factors affecting the progression of MCI in elderly individuals comprise gender (female), preferring to use animal fat, lack of exercise in the past, increased age, increased SBP, and increased DBP. Additionally, a non-linear relationship between blood pressure levels and MCI progression was confirmed, with the critical blood pressure management threshold for MCI onset falling within the prehypertensive range.

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Data availability

Any data not published within the article is available in a public repository.

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Acknowledgements

Data used in this study was derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort (https://opendata.pku.edu.cn/dataverse/CHADS). Launched in 1998, the CLHLS conducted follow-up surveys in 2000, 2002, 2005, 2008-2009, 2011-2012, 2014, and 2017-2018. This cohort spans the majority of the provinces in China and aims to investigate the factors associated with healthy human longevity. It offers a wealth of comprehensive information, including socio-demographic characteristics, health status, and daily activities of the elderly.

Funding

The study was supported by the Key Science and Technology Program Projects of Zigong, China (2022ZCNKY19).

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Authors and Affiliations

  1. Health Management Center, Zigong Fourth People’s Hospital, 19 Tanmulin Street, Zigong, 643000, People’s Republic of China

    Fuliang Yi, Yang Gao, Xin Liu, Yujuan Ying, Qiaojin Xie, You You, Qian Zha, Canjing Luo, Min Ni, Qiuping Wang & Yuanfang Zhu

  2. Department of Public Health, Zigong Fourth People’s Hospital, 19 Tanmulin Street, Zigong, 643000, People’s Republic of China

    Fuliang Yi

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  1. Fuliang Yi
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Contributions

The paper was and written by FY. FY and YG were responsible for the overall idea design of the paper. XL, YY, QX, and YY reviewed and substantively revised the paper. QZ and CL were responsible for data acquisition and analysis, MN and QW responsible for quality evaluation of kinds of literature. YZ served as the overall lead and took responsibility for the paper. All authors listed made significant contributions to the work, both in terms of direct involvement and intellectual input.

Corresponding author

Correspondence to Yuanfang Zhu.

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Ethical approval and Informed consent

The CLHLS cohort study has obtained approval from Peking University’s Research Ethics Committee (IRB00001052-13074). All participants or their authorized representatives have provided written informed consent.

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Table 4

Table 4 The CMMSE utilized in the CLHLS cohort
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Yi, F., Gao, Y., Liu, X. et al. A non-linear relationship between blood pressure and mild cognitive impairment in elderly individuals: A cohort study based on the Chinese longitudinal healthy longevity survey (CLHLS). Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07539-z

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