Age and frailty shift optimal blood pressure for cognitive aging
Global cognitive aging rates showed an inverted U-shaped link with systolic pressure, peaking at 120.1 mmHg overall and 130.8 mmHg in prefrail older adults.
Journal of Alzheimer's Disease
Researchers analyzed 4,723 non-frail adults aged 45 and older from the China Health and Retirement Longitudinal Study tracked between 2011 and 2018. The team categorized participants into middle-aged (45–64 years) or older (65 years and older) and robust or prefrail groups. Using linear regression and restricted cubic splines, they evaluated how systolic blood pressure associates with annual cognitive aging rates measured by Z-scores. Overall, the association followed an inverted U-shaped curve peaking at 120.1 mmHg (p-nonlinear = 0.049). Age and frailty status jointly modified this relationship (interaction p = 0.010). Prefrail older adults displayed a distinct curve with a higher peak at 130.8 mmHg (p-nonlinear = 0.005). Episodic memory analyses showed highly concordant patterns.
Why it matters
The findings indicate that physiological vulnerability and chronological age interact to influence brain aging, suggesting that strict blood pressure targets may not suit prefrail older individuals.
Caveats
The study relied on an observational cohort design, which cannot establish causality, and was limited to non-frail participants from a single national database.
The paper
Third Affiliated Hospital of Sun Yat-sen University
Journal of Alzheimer's Disease · 29 Sep 2026