Blood pressure at age 60–65 versus age 70–75 and vascular dementia: a population based observational study

Abstract

BackgroundVascular dementia (VaD) is the second most common form of dementia. However, there were mixed evidences about the association between blood pressure (BP) and risk of VaD in midlife and late life and limited evidence on the association between pulse pressure and VaD.MethodsThis is a population-based observational study. 265,897 individuals with at least one BP measurement between the ages of 60 to 65 years and 211,116 individuals with at least one BP measurement between the ages of 70 to 75 years were extracted from The Health Improvement Network in United Kingdom. Blood pressures were categorized into four groups: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Cases of VaD were identified from the recorded clinical diagnoses. Multivariable survival analysis was used to adjust other confounders and competing risk of death. All the analysis were stratified based on antihypertensive drug use status. Multiple imputation was used to fill in missing values.ResultsAfter accounting for the competing risk of death and adjustment for potential confounders, there was an association between higher BP levels in the age 60–65 cohort with the risk of developing VaD (hazard ratio [HR] 1.53 (95% confidence interval: 1.04, 2.25) for prehypertension, 1.90 (1.30, 2.78) for stage 1 hypertension, and 2.19 (1.48, 3.26) for stage 2 hypertension) in the untreated group. There was no statistically significant association between BP levels and VaD in the treated group in the age 60–65 cohort and age 70–75 cohort. Analysis on Pulse Pressure (PP) stratified by blood pressure level showed that PP was not independently associated with VaD.ConclusionHigh BP between the ages of 60 to 65 years is a significant risk for VaD in late midlife. Greater efforts should be placed on early diagnosis of hypertension and tight control of BP for hypertensive patients for the prevention of VaD.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0649-3) contains supplementary material, which is available to authorized users.

Blood pressure control and risk of post-stroke dementia among the elderly: A population-based screening study

“…Some studies reported that high blood pressure at midlife (age 40–64 years) is associated with an increased risk of late-life dementia ( 17 , 18 ). Currently, there is no consensus on the association between blood pressure and dementia in those aged 65 years and above ( 29 , 30 ). On the contrary, some studies ( 16 , 31 ) suggest that hypotension is associated with greater dementia risk in older age, primarily owing to concerns that aggressive blood pressure reduction could cause hypoperfusion of the brain.…”

Relationship Between Arterial Stiffness Index, Pulse Pressure, and Magnetic Resonance Imaging Markers of White Matter Integrity: A UK Biobank Study

“…Similar but even weaker associations were seen between WMH and BP at the age of 73 years ( Aribisala et al, 2014 ). In addition, Peng et al (2017) reported no association between BP levels nor peripheral PP at the age of 70–75 years and the incidence of vascular dementia.…”

“…Likewise, the association between high BP in middle age (age 40–64 years) and increased risk for vascular dementia is well established ( Kennelly et al, 2009 ; Launer et al, 2010 ; Ninomiya et al, 2011 ). However, studies looking at these associations at an older age are sparse and there is no consensus on the association between BP and dementia in individuals aged 75 and above ( Peng et al, 2017 ). In addition, information about the impact of BP and arterial stiffness measures on white matter integrity in people over 75 years old is still lacking.…”

Global cognitive function correlates with P‐wave dispersion in frail hypertensive older adults

“…The exact mechanisms linking PWD and hypertension need to be investigated. Indeed, hypertension is known to lead to endothelial alterations and microvascular dysfunction, increasing inflammation and oxidative stress, 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 which may underlie structural and electro‐mechanical alterations in the heart.…”