Resistant hypertension (RH) is associated with increased risk of cognitive decline and stroke. Exercise and behavioral weight loss have been suggested to improve cognitive functioning among individuals with RH, but their longer-term effects have rarely been studied among hypertensive adults. We examined the impact of lifestyle modification on cognitive outcomes during a one-year follow-up of participants from the TRIUMPH clinical trial among a subset available prior to the COVID-19 pandemic lockdown.

Among the 140 TRIUMPH participants originally randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or to a standardized education and physician advice (SEPA) condition for 4-months. C-LIFE participants underwent supervised, aerobic exercise 3x/week, as well as individual counseling with a behavioral psychologist to modify their diet to adhere to the Dietary Approaches to Stop Hypertension (DASH) diet and reduce their caloric intake. Participants had RH, were sedentary, and overweight or obese at baseline. The intervention resulted in substantial improvements in fitness, weight loss, and reduced blood pressure. During a one-year follow-up, 91 (65%) of C-LIFE participants and 30 (60%) of SEPA. At baseline, 4-months, and one-year, participants underwent a 45-minute assessment of cognitive functioning within three domains: Executive Functioning / Learning, Memory, and Processing Speed. Cognitive functioning was examined separately by domains using repeated measures, mixed modeling in which performance at 4-months and One-Year as the outcome measures. Regression models controlled for age, education, biological sex, creatinine, stroke risk, and the baseline level of the respective outcomes, with treatment group as the predictor of interest.

Participants included 91 individuals (mean age = 63.6 [SD = 8.6]) with RH (mean SBP = 139 mm Hg [SD = 11]), the majority of whom were African-American (60%). Resulted demonstrated that Memory Performance Improved over time for C-LIFE compared to SEPA (P = .041), with the strongest differences at one-year (72.4 [67.6, 77.1] vs. 64.3 [57.2, 71.5]). Executive Functioning / Learning was also greater in C-LIFE compared to SEPA (71.8 [69.6, 73.9] vs. 66.8 [63.5, 70.1], P = .015), whereas we found no group differences in Processing Speed over time (P = .466).

Lifestyle modification may result in longer-term improvements in Memory and Executive Functioning / Learning among individuals with RH.