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Visit-to-visit systolic BP (SBP) variability was assessed using the coefficient of variation (CV) from five annual health check-ups. The outcome was antidementia drug initiation as a proxy for dementia diagnosis and was analyzed using Fine-Gray models, with death as the competing outcome. For participants untreated\/treated with antihypertensive medication, 366\/298 initiated antidementia drugs during 2.20\u2009\u00b1\u20091.19\/2.11\u2009\u00b1\u20091.19 years of follow-up, respectively. The highest SBP-CV sextile was associated with dementia risk regardless of treatment status: hazard ratio of the 6\n                    <jats:sup>th<\/jats:sup>\n                    sextile (SBP-CV\u2009\u2265\u20099.83%) vs. 1\n                    <jats:sup>st<\/jats:sup>\n                    \u20135\n                    <jats:sup>th<\/jats:sup>\n                    sextiles was 1.50 (95% confidence interval [CI]: 1.17\u20131.92) for untreated participants, while for treated participants, the hazard ratio of the 6\n                    <jats:sup>th<\/jats:sup>\n                    sextile (SBP-CV\u2009\u2265\u200910.67%) was 1.43 (95%CI: 1.09\u20131.89) after further adjusting for antihypertensive drug classes and medication adherence assessed by medication possession rate. In the stratification analyses by baseline characteristics, only HbA1c in treated participants demonstrated a significant interaction with SBP-CV for dementia risk; this association was pronounced among treated participants with HbA1c\u2009\u2265\u20096.5% (interaction\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.024). No significant interactions were observed among antihypertensive drugs, poor adherence, and SBP-CV in relation to dementia risk. High visit-to-visit BP variability, indicated by a CV of approximately \u226510%, is associated with dementia, regardless of treatment status. In the treated participants, this association persisted even after accounting for antihypertensive drug classes and medication adherence.\n                  <\/jats:p>","DOI":"10.1038\/s41440-025-02451-1","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:38:55Z","timestamp":1762756735000},"page":"372-383","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Visit-to-visit blood pressure variability and dementia risk after considering antihypertensive treatment: real-world data from the Japanese National Health Insurance"],"prefix":"10.1038","volume":"49","author":[{"given":"Michihiro","family":"Satoh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Nobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Iwabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahito","family":"Yagihashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiya","family":"Izumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahisa","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Toyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Muroya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Ohkubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohito","family":"Metoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2451_CR1","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","volume":"7","author":"G. 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