Associations of cumulative uric acid-to-high-density lipoprotein cholesterol ratio and its trajectories with cognitive outcomes in middle-aged and older adults with hypertension

The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) integrates uric acid and lipid-related metabolic information, but its longitudinal association with cognitive outcomes in adults with hypertension is unclear. We analyzed data from 1,049 participants aged 45 years or older with hypertension in the China Health and Retirement Longitudinal Study (2011–2020). Cumulative UHR was calculated from 2011 to 2015 measurements, and dynamic UHR trajectories were identified using K-means clustering. Logistic and linear regression models evaluated incident cognitive impairment and changes in cognitive scores. Restricted cubic spline (RCS) analyses were performed to assess dose–response relationships, and subgroup and sensitivity analyses were conducted to evaluate the robustness of the findings. During follow-up, 100 participants (9.5%) developed incident cognitive impairment. In the fully adjusted model, each 1-SD increment in cumulative UHR was associated with higher odds of incident cognitive impairment (OR = 1.48; 95% CI, 1.14–1.91; P = 0.003). Q4 versus Q1 was associated with higher odds (OR = 2.95; 95% CI, 1.34–6.46; P = 0.007), as was Cluster 3 versus Cluster 1 (OR = 2.36; 95% CI, 1.05–5.26; P = 0.037). Each 1-SD increment in cumulative UHR was also associated with greater declines in global cognitive function (β = −0.25; 95% CI, − 0.46 –−0.05; P = 0.015) and mental status (β = −0.15; 95% CI, − 0.31–0.00; P = 0.049), whereas no significant association was observed with episodic memory. RCS analyses showed significant overall associations of cumulative UHR with incident cognitive impairment, global cognitive function, and mental status, with no evidence of significant nonlinearity. Subgroup and sensitivity analyses yielded generally consistent findings, supporting the robustness of the main results. Higher cumulative UHR and a persistently high UHR trajectory were associated with adverse cognitive outcomes among adults with hypertension.