Lifestyle modification may help preserve cognitive functioning among individuals with resistant hypertension, with the C-LIFE group showing more preserved cognitive functioning compared to SEPA at one-year follow-up.
Key Findings
Results
The C-LIFE group had significantly more preserved cognitive functioning compared to the SEPA group at one-year follow-up.
C-LIFE group cognitive z-score: -0.26 [95% CI: -0.40, -0.12] versus SEPA group: -0.60 [95% CI: -0.81, -0.39]
Effect size d = 0.44, p = 0.008
Both groups showed some decline, but SEPA showed greater decline
Cognitive function was assessed using a 45-minute test battery incorporating tests of Executive Function/Learning, Memory, and Processing Speed
Regression-based models incorporating reliable change indices were used to assess cognitive change
Results
Reduced Pittsburgh Sleep Quality Index (PSQI) sleep symptoms were associated with more preserved cognitive function at one-year follow-up.
B = -0.18, p = 0.050 per 3-point change in PSQI score
Sleep quality was assessed using PSQI as part of the one-year follow-up assessments
The association suggests that better sleep quality corresponded to better preserved cognitive functioning
Results
Treatment condition (C-LIFE vs. SEPA) did not improve functional near-infrared spectroscopy (fNIRS) markers of cerebrovascular reactivity.
Cerebrovascular reactivity was assessed using functional near infrared spectroscopy (fNIRS)
Despite no treatment effect on fNIRS outcomes, changes in weight and physical activity were associated with fNIRS outcomes
fNIRS was used as a measure of cerebrovascular reactivity during the one-year follow-up
Results
Changes in weight and physical activity were associated with fNIRS cerebrovascular reactivity outcomes at one-year follow-up.
Physical activity was assessed using actigraphy at the one-year follow-up
Body mass index (BMI) was also assessed at the one-year follow-up
These associations were observed independently of the overall treatment effect on fNIRS markers
Methods
The one-year follow-up retained 91 of 140 originally randomized TRIUMPH participants prior to COVID-19 lockdown.
91 participants (65% of original 140) were available for one-year assessments
Mean age was 63.6 years (SD = 8.6)
Participants were evenly distributed in biological sex and race/ethnicity, and tended to be college-educated
Participants were originally randomized to 4-month C-LIFE or SEPA conditions before being followed up at one year
Data collection was limited by the COVID-19 lockdown
Background
Treatment resistant hypertension (TRH) is associated with increased risk of cognitive decline, which may be reduced by healthy lifestyle changes.
The TRIUMPH trial examined a cardiac rehabilitation-based lifestyle program (C-LIFE) versus Standardized Education and Physician Advice (SEPA) as the comparator condition
The original randomized intervention lasted 4 months, with the current analysis examining one-year outcomes
The study assessed multiple lifestyle factors including sleep quality, BMI, physical activity, and cerebrovascular reactivity
What This Means
This research suggests that a structured lifestyle program based on cardiac rehabilitation can help protect brain function in people with treatment-resistant high blood pressure (hypertension that doesn't respond well to medication). In the TRIUMPH trial, participants who completed a 4-month exercise and lifestyle program called C-LIFE showed less cognitive decline over one year compared to those who only received standard health education and physician advice. Both groups showed some decline in cognitive test scores, but the decline was notably smaller in the C-LIFE group, with a meaningful effect size.
The study also found that better sleep quality was linked to better preservation of cognitive function, regardless of which group participants were in. Interestingly, while the lifestyle program itself did not directly improve measures of blood flow and brain reactivity (assessed using a light-based brain imaging technique called fNIRS), changes in body weight and physical activity levels were associated with improvements in these brain blood flow markers. This suggests that specific components of lifestyle change — particularly exercise and weight management — may benefit brain health through effects on blood vessel function.
This research matters because treatment-resistant hypertension affects a significant portion of people with high blood pressure and puts them at elevated risk for cognitive decline and dementia. The findings indicate that structured lifestyle interventions — even those originally designed for heart health — may offer meaningful protection for brain health as well, and that improving sleep quality could be an important additional target for preserving cognitive function in this vulnerable population.
Smith P, Blumenthal J, Ingle K, Watkins L, Avorgbedor F, Mabe S, et al.. (2026). Lifestyle, sleep quality, and cognitive function in resistant hypertension: One-year follow-up from the TRIUMPH trial.. Journal of Alzheimer's disease : JAD. https://doi.org/10.1177/13872877251409716