ABSTRACT NUMBER: ESOC2026A131 BLOOD PRESSURE VARIABILITY AND SEX DIFFERENCES IN COGNITIVE DECLINE: A POOLED COHORT ANALYSIS OF ARIC, CHS, FOS, MESA, AND CARDIA IN THE BP COG STUDY

Abstract Background and aims Women have faster cognitive decline than men, but prior studies have not evaluated the role of blood pressure variability. Methods This pooled analysis included participants from five US longitudinal cohort studies (1971-2019): ARIC, CHS, FOS, MESA, and CARDIA. We estimated change in global cognition by sex using a linear mixed-effects model. Analyses adjusted for cohort, age, race, education, income, APOE, alcohol use, smoking, physical activity, myocardial infarction and atrial fibrillation, cumulative risk factors (estimated fasting glucose, waist circumference, body mass index, low-density lipoprotein cholesterol, and mean systolic blood pressure [SBP]), and treatment (Model 1). BP variability (intraindividual standard deviation [SD] of SBP across study visits) was added in Model 2. All covariates were interacted with follow-up time. Results We included 20,432 participants free of stroke and dementia with complete covariate data; mean (SD) baseline age was 50.1 (16.6) years, 54.5% female, 19.6% Black, and 80.4% White. Median (IQR) follow-up was 22.1 (9.0-29.8) years. In Model 1, women’s global cognition declined significantly faster than men (-0.059 points/year, 95% CI -0.070, -0.048, P < 0.001). After further adjustment (Model 2), higher SBP variability was associated with faster global cognitive decline (-0.001 points/year/mmHg, 95% CI -0.002, -0.000009, P = 0.048). The sex difference in decline (-0.058 points/year, 95% CI -0.069, -0.047, P < 0.001) showed minimal change by adding SBP variability. Conclusions Even after accounting for cumulative vascular risk factors and other characteristics, SBP variability was independently associated with faster cognitive decline but did not suggest an explanation for the sex difference in cognitive decline. Conflict of interest Brian Stamm: nothing to disclose. Rachael Whitney: nothing to disclose. Wan-Ling Hsu: nothing to disclose. Wen Ye: nothing to disclose. Rebecca Gottesman: nothing to disclose. Kristine Yaffe: nothing to disclose. Hugo Aparicio: nothing to disclose. Timothy Hughes: nothing to disclose. W. T. Longstreth: receives support from NIH for several projects. Deborah Levine: reports grant funding from the NIH and consulting for Northwestern University and Tufts University on NIH-funded projects.