Associations Between Hypertension Care Cascade, Cognitive Function, and Cardiovascular Disease in Middle-Aged and Older Adults: the Exacerbated Role of Social Isolation

Background: The role of social isolation in the connections between the hypertension care cascade, cognitive function, and cardiovascular disease (CVD) remains unclear. This study aims to investigate the relationships between the hypertension care cascade, cognitive performance, and CVD among middle-aged and older adults with varying levels of social isolation. Methods: Eight thousand two hundred eighty-seven participants aged 45 years and older from the China Health and Retirement Longitudinal Study were included in the analysis. Participants were categorized based on their social isolation status, either as socially isolated or not. Both multivariable linear regression and logistic regression models were employed. All analyses were weighted to account for the multistage, probability-proportional-to-size sampling design of the study. Hypertension was defined according to European, Chinese, and American guidelines. Results: The weighted rates of hypertension awareness, treatment, and control were 55.0%, 44.5%, and 25.4%, respectively, with a more favorable performance in the hypertension care cascade observed among individuals without social isolation. When applying American guidelines to define hypertension, the rates of awareness, treatment, and control significantly declined, irrespective of social isolation status. Compared to non-hypertensive individuals, participants with treated and controlled blood pressure (BP) exhibited similar cognitive function and odds of CVD. In contrast, individuals with treated but uncontrolled BP and those who were unaware of hypertension demonstrated poorer cognitive performance and a heightened risk of CVD. Social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD risk. Isolated individuals who are unaware of hypertension faced a more higher risk of worsen prognosis than that of the non-isolated individuals (P for interaction < 0.05). Conclusions: Individuals experiencing social isolation exhibited poor performance in the hypertension care cascade. Furthermore, social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD. Our study emphasizes that addressing social isolation could be a significant factor for improving the hypertension care cascade and health outcomes among middle-aged and older adults in China.