“Do It Yourself”: Home Blood Pressure as a Predictor of Traditional and Everyday Cognitive Performance in Older Adults

Uncontrolled blood pressure is a leading cardiovascular risk factor that is associated with cognitive decline in later life. Hypertension guidelines advocate for home blood pressure (HBP) monitoring given its superior reliability and prognostic utility regarding risk of dementia and stroke compared to office blood pressure (OBP). Yet, the association between HBP and cognitive performance remains unexplored. We examined HBP as a predictor of traditional and everyday cognitive performance in a group of community-dwelling older adults aged 60 and over (N = 133; 54.1% hypertensive). Participants attended a one-hour HBP education seminar and monitored their blood pressure at home for seven days. Approximately 96% of participants achieved adequate to perfect HBP monitoring compliance based on recording accuracy and completed readings. Superior test-retest and within-class reliability was also observed with HBP compared to OBP readings. Higher home systolic blood pressure and pulse pressure predicted worse processing speed, executive function, and everyday cognitive ability after accounting for a hypertensive diagnosis. Lower home diastolic blood pressure predicted worse everyday cognition. Regarding research-quality OBP averaged across multiple readings, similar relationships were found when predicting everyday cognition. This is the first study to validate the utility of HBP as a predictor of cognitive performance in older adults using a comprehensive neuropsychological battery. The present findings support that highly reliable home readings can successfully be attained in an older community-dwelling cohort when employing standardized assessment methods. Novel relationships between HBP and cognitive performance were revealed across traditional cognitive measures, as well as tasks reflecting “real-world” knowledge and problem-solving ability. Domains sensitive to vascular pathology (i.e., processing speed, executive function) and everyday cognition may be particularly vulnerable to uncontrolled HBP. Elevated pulse pressure, through a combination of increased systolic and decreased diastolic blood pressure, may be a risk factor for reduced cognitive function in older age. The importance of standardized home blood pressure measurement is discussed, as well as its implications for hypertension management, cognitive and everyday function in older adults.