Cognitive impairment was common (30.3%) among community-dwelling older adults with hypertension in tropical China, with older age and depressive symptoms associated with higher odds, while higher educational attainment, moderate income, and higher BMI were associated with lower odds.
Key Findings
Results
The prevalence of cognitive impairment among community-dwelling older adults with hypertension in tropical China was 30.3%.
735 participants were included, with a mean age of 72.3 ± 7.7 years and 57.6% women
223 of 735 participants had cognitive impairment
Participants were recruited from community health centers in Haikou, China between 2023 and 2025
Cognitive function was assessed using the Chinese Mini-Mental Status Examination with education-adjusted cutoff values
All participants were aged ≥60 years with self-reported, physician-diagnosed hypertension
Results
Participants aged ≥80 years had significantly higher odds of cognitive impairment compared to those aged 60–69 years.
OR = 2.21, 95% CI: 1.34–3.64 in the fully adjusted model
This finding was supported by sensitivity analyses
Age was evaluated as a categorical variable with 60–69 years as the reference group
Age- and sex-stratified analyses were conducted to evaluate robustness
Results
Depressive symptoms were associated with increased odds of cognitive impairment.
OR = 1.87, 95% CI: 1.03–3.39 in the fully adjusted multivariable logistic regression model
This association was identified as one of the primary factors associated with CI
Sensitivity analyses generally supported the robustness of this finding
Results
Higher educational attainment was associated with lower odds of cognitive impairment.
This association was identified in the fully adjusted multivariable logistic regression model
Education-adjusted cutoff values were used for cognitive assessment, suggesting education was carefully accounted for in the measurement of CI
Higher educational attainment was one of three factors associated with lower odds of CI
Results
Medium monthly income was associated with lower odds of cognitive impairment.
Medium monthly income (not the lowest or highest category) was protective against CI in the fully adjusted model
This was one of the socioeconomic factors identified in multivariable logistic regression
The finding highlights the role of social determinants in cognitive health among this population
Results
Higher BMI was associated with lower odds of cognitive impairment in this population.
Higher BMI was associated with lower odds of CI in the fully adjusted model
This finding is notable as higher BMI is often associated with adverse health outcomes in other contexts
Sensitivity analyses generally supported the robustness of this finding
This relationship may reflect characteristics specific to older adults in this tropical Chinese population
Results
A significant sex-by-marital status interaction was observed in relation to cognitive impairment.
P for interaction = 0.015 for the sex × marital status interaction
Stratified analyses suggested potential sex differences in the association between marital status and CI
Formal interaction analysis confirmed the statistical significance of this interaction
The finding highlights the importance of sex-specific approaches in cognitive health strategies
What This Means
This research suggests that nearly one in three older adults with high blood pressure living in the community in tropical China (specifically Haikou) showed signs of cognitive impairment — problems with memory and thinking. The study surveyed 735 people aged 60 and older who had been diagnosed with hypertension, and used a standard memory and thinking test to identify those with cognitive impairment. Being 80 years or older and having symptoms of depression were linked to a greater likelihood of cognitive impairment, while having more education, a moderate monthly income, and a higher body weight were linked to a lower likelihood.
One particularly notable finding is that the relationship between marital status and cognitive impairment differed between men and women. This suggests that social factors like partnership and companionship may affect brain health differently depending on sex, which could be important when designing community programs to support older people's cognitive health. The study also found that social and economic circumstances — not just medical factors — play an important role in whether older hypertensive adults develop cognitive problems.
This research suggests that community health programs targeting older adults with hypertension should take a broad approach that addresses mental health (particularly depression), social support, and economic wellbeing, rather than focusing only on blood pressure management. The findings also highlight a gap in research from tropical regions of China, where climate, lifestyle, and population characteristics may differ from other parts of the country, and point to the need for tailored, sex-sensitive strategies to protect cognitive health in aging populations.
Peng L, Wang X, Cao W, Zhang P, Yu D, Liu H, et al.. (2026). Cognitive impairment and associated factors among community-dwelling older adults with hypertension in tropical China.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1900335