Pulse Pressure-Heart Rate Index Predicts Incident Dementia in Hypertensive Adults: A Post Hoc Analysis of the SPRINT Trial

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND The Pulse Pressure-Heart Rate Index (PPHRi), a composite marker of vascular stiffness and autonomic tone, has emerged as a predictor of cardiovascular outcomes. However, the association with incident dementia remains poorly characterized. We examined whether baseline PPHRi predicts probable dementia among participants in the Systolic Blood Pressure Intervention Trial (SPRINT). METHODS We analyzed 8,560 participants with baseline data from SPRINT, a multicenter randomized trial comparing intensive vs. standard blood pressure control. PPHRi was calculated as pulse pressure divided by resting heart rate and analyzed continuously, by tertiles, and by median split. The outcome was probable dementia, modeled using Cox proportional hazards regression adjusted for age and sex. RESULTS Mean age was 68.0 years (SD: 9.3); 64.9% were male. Median PPHRi was 0.92 (IQR: 0.41). Over follow-up, 324 dementia cases occurred. Each unit increase in PPHRi was linked to >3-fold higher dementia risk (HR: 3.33; 95% CI: 2.55-4.35). Compared to the lowest tertile, middle and highest tertiles had higher risk (HRs: 1.74 [1.26- 2.39] and 2.89 [2.14-3.89]). High vs. low PPHRi (binary) also showed elevated risk (HR: 2.12; 95% CI: 1.68-2.67). CONCLUSION Elevated PPHRI was independently associated with increased risk of dementia in hypertensive adults. These findings support the utility of PPHRI as a simple, non-invasive biomarker for dementia risk stratification and warrant validation in additional studies.

Volume

87

Issue

13 Suppl

First Page

A204

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A204

DOI

10.1016/j.jacc.2026.02.505

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