Research in Context 1Evidence before this study 2We searched PubMed for reports on associations between blood pressure (BP) and grey 3 matter volumes (GMV) in young adults by use of the MeSH terms [hypertension OR blood 4 pressure] AND [atrophy OR grey matter OR gray matter OR brain volume] and no language 5 or date restrictions. We found a systematic review and meta-analysis from 2013 which 6 identified 28 studies that investigated associations of higher BP with GMV across ages. In 7 the majority of studies, higher BP or hypertension was associated with lower total or regional 8 GMV. Qualitatively, these reductions were predominant in frontal and (medial) temporal 9 lobes. The meta-analysis revealed consistent reductions in hippocampal volumes with high 10 BP/hypertension across studies. However, none of the reports investigated BP-GMV 11 associations in young adults, i.e. younger than 40 years of age. 12
Added value of this study 13In this image-based meta-analysis of four previously unpublished cross-sectional studies that 14 included 423 healthy young adults in total, resting BP ≥120/80 mmHg was associated with 15 lower grey matter volume in several brain regions, including frontal, parietal and subcortical 16 structures (including hippocampus). Our study suggests that subtle pressure-related brain 17 alterations can be observed before 40 years of age and in ranges where BP is still 18 considered "normal" by current guidelines for the management of hypertension. 19
Implications of all the available evidence 20Our study is the first to show that BP-associated grey matter alterations emerge continuously 21 across the range of BP and earlier in adulthood than previously assumed. Elevated BP is 22 globally highly prevalent and an important risk factor for cerebrovascular disease and overall 23 health loss. Our results suggest that treating hypertension or maintaining a lower BP in early 24 adulthood might be essential for preventing the pathophysiological cascade of asymptomatic 25 cerebrovascular disease to symptomatic end-organ damage, such as stroke and dementia. 26International license It is made available under a (which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint . http://dx.doi.org/10.1101/239160 doi: bioRxiv preprint first posted online Dec. 24, 2017;
3In light of our results, large-scale prospective brain imaging studies should include young 27 adults to investigate whether brain changes related to sub-hypertensive BP in early 28 adulthood could serve as early biomarkers for subsequent development of cerebrovascular 29 disease later in life. Such data would provide evidence for future recommendation guidelines 30 for the management of elevated BP in young adults and for the prevention of 31 cerebrovascular disease at older ages. Our results also speak in favor of considering 32 individual BP levels as continuous measures -in addition to a categorical cut-off -which 33 could facilitate the init...