Effects of Higher Normal Blood Pressure on Brain Are Detectable before Middle-Age and Differ by Sex

Abstract

Background: To quantify the association between blood pressure (BP) across its full range, brain volumes and white matter lesions (WMLs) while investigating the effects of age, sex, body mass index (BMI), and antihypertensive medication. Methods: UK Biobank participants (n = 36,260) aged (40–70) years were included and stratified by sex and four age groups (age ≤ 45, 46–55, 56–65 and > 65 years). Multi-level regression analyses were used to assess the association between mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and brain volumes segmented using the FreeSufer software (gray matter volume [GMV], white matter volume [WMV], left [LHCV] and right hippocampal volume [RHCV]) and WMLs. Interaction effects between body mass index (BMI), antihypertensive medication and BP in predicting brain volumes and WMLs were also investigated. Results: Every 10 mmHg higher DBP was associated with lower brain volumes (GMV: −0.19%–−0.40%) [SE = 47.7–62.4]; WMV: −0.20–−0.23% [SE = 34.66–53.03]; LHCV: −0.40–−0.59% [SE = 0.44–0.57]; RHCV: −0.17–−0.57% [SE = 0.32–0.95]) across all age groups. A similar pattern was detected in both sexes, although it was weaker in men. Every 10 mmHg higher MAP was associated with larger WMLs across all age groups but peaked >65 years (1.19–1.23% [SE = 0.002]). Both lower BMI and anti-hypertensive medication appeared to afford a protective effect. Conclusion: Higher BP is associated with worse cerebral health across the full BP range from middle adulthood and into old age.

Associations of arterial thickness, stiffness and blood pressure with brain morphology in early adolescence: A prospective population-based study

“…In the same cohort, midlife hypertension 16 and increasing blood pressure trajectories from young adulthood to middle age 17 were associated with lower cerebral perfusion and volumetric markers of poor white- and grey-matter health at age 50. Blood pressure was also linearly associated with reduced grey-matter volumes and white matter microstructural integrity at age 40 in the FHS-G3 sample 18 and with grey matter and white matter lesion volume before the age of 45 in the UK Biobank 19 .…”

Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: The COSMIC consortium

“…A rich body of research has examined risk factors for WMHs 1 , 2 and associations between WMHs and cognition. 3 , 4 In particular, studies have found a heavier burden of WMHs with hypertension, 5 higher blood pressure in normal range, 6 , 7 diabetes, 8 cardiovascular disease, 9 excessive alcohol consumption, 10 and insufficient physical activity. 3 , 10 , 11 Poorer performance in the cognitive domains of processing speed 1 and executive function 12 has also been associated with WMHs.…”

Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: the COSMIC consortium

“…A rich body of research has examined risk factors for WMH (1, 2) and associations between WMH and cognition (3, 4). In particular, studies have found a heavier burden of WMH with hypertension (5), higher blood pressure in normal range (6, 7), diabetes (8), cardiovascular disease (9), excessive alcohol consumption (10), and insufficient physical activity (3, 10, 11). Poorer performance in the cognitive domains of processing speed (1) and executive function (12) has also been associated with WMH.…”