Hypertension, Antihypertensive Treatment, and Memory Decline: Consistent and Divergent Patterns in Aging Populations Across 4 Countries, 2010-2019

INTRODUCTION: Memory decline is a hallmark of all-cause dementia. Hypertension, a highly prevalent and modifiable risk factor, is a critical intervention target. Cross-national, long-term studies examining the relationship between hypertension management and long-term memory decline remain limited. METHODS: The authors analyzed 2010-2019 data from 4 nationally representative aging cohorts. Hypertension (blood pressure ≥140/90 mmHg or antihypertensive medications use) was categorized as treated and untreated. Memory was assessed using immediate and delayed word recall tasks. Linear mixed-effects models evaluated memory trajectories by hypertension and treatment status. Pooled analyses examined cross-country differences. Data analysis occurred from December 2024 to January 2026. RESULTS: Compared with nonhypertensive participants, those with hypertension had a faster annual decline in the U.S. (-0.010; 95% CI= -0.015, -0.006) and England (-0.011; 95% CI= -0.018, -0.004). Participants with untreated hypertension had a slower annual decline in the U.S. (0.010; 95% CI=0.003, 0.017) but a faster decline in China (-0.022; 95% CI= -0.034, -0.011) than participants with treated hypertension. Pooled analyses showed no cross-country differences in the association between hypertension and memory; however, untreated hypertension was associated with faster memory decline in Mexico (-0.028; 95% CI= -0.051, -0.006) and China (-0.032; 95% CI= -0.045, -0.020) than treated hypertension in the U.S. CONCLUSIONS: Hypertension and treatment status are associated with memory decline in country-specific patterns. These findings highlight hypertension as a key modifiable risk factor and support prevention and treatment to promote cognitive health. Tailored approaches that align with local healthcare systems and population needs are essential.