Higher Adiposity Is Associated With Slower Cognitive Decline in Hypertensive Patients: Secondary Analysis of the China Stroke Primary Prevention Trial

BACKGROUND: Obesity is a risk factor for many diseases. However, the potential association between adiposity and cognitive decline in hypertensive patients is inconclusive. We performed a secondary data analysis of the CSPPT (China Stroke Primary Prevention Trial) to examine whether adiposity is correlated with longitudinal cognitive performance in hypertensive adults. METHODS AND RESULTS: The analysis included 16 791 patients in the CSPPT who received at least 2 cognitive assessments by the Mini‐Mental State Examination (MMSE) during the follow‐up (median, 4.5 years; interquartile range, 4.2–4.8 years). Outcomes included changes in MMSE scores and cognitive impairment (defined as MMSE score less than education‐specific cutoff point). A marked reduction in MMSE scores at the final (compared with at the 1‐year) follow‐up was apparent in both men (n=4838; mean [SD] score, 0.41 [3.62]) and women (n=7190; mean [SD] score, 1.07 [4.61]; both P<0.001). Analysis using a mixed‐effects model revealed an association between higher body mass index with less MMSE decline, even after controlling for demographics and comorbidities (men, β=0.0134 [SE, 0.0036]; women, β=0.0133 [SE, 0.0034]; both P<0.001). A total of 1037 men (15.3%) and 3317 women (33.1%) developed cognitive impairment. In multivariable Cox regression analyses, being obese in men (11.3% versus 18.0%; hazard ratio, 0.75; 95% confidence interval, 0.60–0.94) and women (30.1% versus 36.5%; hazard ratio, 0.82; 95% confidence interval, 0.74–0.91) was a protective factor against cognitive impairment compared with normal body mass index. CONCLUSIONS: Higher adiposity is independently associated with slower cognitive decline in Chinese hypertensive adults. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885 CSPPT.