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BP From Midlife to Late Life Tied to Risk for Subsequent Dementia

TUESDAY, Aug. 13, 2019 -- The risk for subsequent dementia is significantly increased for blood pressure patterns of midlife and late-life hypertension as well as midlife hypertension and late-life hypotension; and intensive blood pressure treatment is associated with a smaller increase in cerebral white matter lesion volume, according to two studies published in the Aug. 13 issue of the Journal of the American Medical Association.

Keenan A. Walker, Ph.D., from Johns Hopkins Hospital in Baltimore, and colleagues enrolled 4,761 adults during midlife (1987 to 1989) and followed them over six visits (through 2016 to 2017). The researchers found that compared with those who remained normotensive, participants in the midlife and late-life hypertension group and in the midlife hypertension and late-life hypotension group had a significantly increased risk for subsequent dementia (hazard ratios, 1.49 and 1.62, respectively). Sustained hypertension in midlife was associated with dementia risk, irrespective of late-life blood pressure (hazard ratio, 1.41). The risk for mild cognitive impairment was increased in association with midlife hypertension and late-life hypotension only versus normotension (odds ratio, 1.65).

Ilya M. Nasrallah, M.D., Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues examined the change in total white matter lesion volume among adults aged 50 years or older with hypertension randomly assigned to intensive treatment or standard treatment (355 and 315 participants, respectively). The researchers found that mean white matter lesion volume increased from 4.57 to 5.49 cm³ (difference, 0.92 cm³; 95 percent confidence interval, 0.69 to 1.14) in the intensive treatment group compared with an increase from 4.40 to 5.85 cm³ (difference, 1.45 cm³; 95 percent confidence interval, 1.21 to 1.70) in the standard treatment group (between-group difference in change, −0.54 cm³; 95 percent confidence interval, −0.87 to −0.20).

"It is imperative that these nuanced effects of blood pressure on brain health inform future therapeutic approaches to prevent dementia," write the authors of an accompanying editorial.

Several authors from both studies disclosed ties to the pharmaceutical industry; in the Nasrallah study, azilsartan and chlorthalidone (combined with azilsartan) were provided by Takeda Pharmaceuticals.

Abstract/Full Text - Walker (subscription or payment may be required)
Abstract/Full Text - Nasrallah (subscription or payment may be required)
Editorial (subscription or payment may be required)

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Posted: August 2019

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