Wider pulse pressure tracks with weaker memory

Blood pressure is usually discussed as two numbers, but the gap between them — pulse pressure — is often read as a marker of how stiff the large arteries have become. Because the brain is heavily dependent on a steady blood supply, researchers have long suspected that a stiffer, more pulsatile circulation could show up as poorer thinking and memory in later life. Individual studies have pointed in different directions, and different cognitive domains may not behave the same way. This review set out to pull that scattered literature together and ask which cognitive domains, if any, track with pulse pressure.

The authors searched PubMed, PsycInfo, Embase and Scopus from inception to July 2025 for studies reporting an association between pulse pressure and cognitive function. From 4171 publications identified, 43 studies met the inclusion criteria. Results were both summarised narratively and pooled using fixed-effects meta-analysis. The included studies covered seven cognitive domains: global cognition, memory, language, attention, executive function, processing speed and visuospatial ability, and included both cross-sectional and longitudinal designs.

The meta-analysis found a negative association between pulse pressure and memory, and this appeared in both cross-sectional and longitudinal studies. Processing speed, executive function and language were also negatively associated with pulse pressure, but mainly in cross-sectional studies, with only limited longitudinal support. Counterintuitively, the pooled analysis showed a positive association between pulse pressure and global cognition. There was limited evidence of any association with attention or visuospatial ability, and studies summarised narratively rather than pooled gave inconsistent results.

This extends the broader idea that vascular ageing and brain ageing travel together, while complicating the simple version of that story. If pulse pressure were straightforwardly bad for cognition, you would not expect global cognition to move in the opposite direction to memory. The mixed picture may reflect differences in how populations, ages and cognitive tests were handled across the 43 studies. Key open questions remain: whether pulse pressure adds anything beyond conventional blood pressure measures, and whether changing it changes cognitive trajectories at all.

This is a reason to think of the spread between your two blood pressure numbers as potentially informative about brain ageing, not just the top number. It is not evidence that a wide pulse pressure causes memory loss, and no intervention was tested here. The most consistent signal was for memory, which is also the domain most people notice changing with age. If your blood pressure readings are being tracked anyway, the gap between the numbers is one more thing a clinician may find worth discussing.