Midlife Hypertension and 20-Year Cognitive Change

Gottesman, Rebecca F.; Schneider, Andrea L.C.; Albert, Marilyn; Alonso, Álvaro; Bandeen‐Roche, Karen; Coker, Laura H.; Coresh, Josef; Knopman, David S.; Power, Melinda C.; Rawlings, Andreea M.; Sharrett, A. Richey; Wruck, Lisa; Mosley, Thomas H.

doi:10.1001/jamaneurol.2014.1646

Cited by 385 publications

(224 citation statements)

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“…Higher midlife SBP levels have been consistently associated with lower cognitive function in later life 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Most studies have assessed cognitive function at a single time point,4, 5, 6, 7, 8, 9 and, thus, our results have extended our understanding of this relationship by taking cognitive decline into account.…”

Section: Discussionsupporting

confidence: 60%

“…Therefore, characterization of individual DBP in midlife by a single measurement may be limited, and this might have contributed to the inconsistent results 5, 6, 8, 30. Indeed, a prior study from the ARIC Study demonstrated that higher DBP at visit 2 was associated with a steeper decline in global cognition from visit 2 to visit 5 11. The inconsistency may be attributable to the definition of DBP (ie, we defined DBP on the basis of 4 clinic BP measurements [from visit 1 to visit 4 BPs] over 9 years).…”

Section: Discussionmentioning

confidence: 99%

“…PP from midlife on is a measure of pulsatile pressure load and most representative of aortic stiffness 31, 32. The association between arterial stiffness and cognition has been reported 11, 36, 37. The potential underlying mechanisms include the following: (1) excessive pulsatile mechanistic forces on the cerebrovasculature; (2) existing common pathways between arterial stiffness and cognition (eg, environmental and neurohormonal factors), inflammation, and oxidative stress38; and (3) impaired β amyloid clearance and τ‐mediated neurodegeneration 39, 40…”

Section: Discussionmentioning

confidence: 99%

“…Evidence supporting a link between midlife blood pressure (BP) levels and late‐life cognitive outcomes continues to accumulate 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. In addition to BP levels, BP variability may be associated with cognitive function 12, 13, 14, 15, 16, 17, 18.…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study

Yano

Griswold

Wang

et al. 2018

JAHA

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BackgroundTo understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change.Methods and ResultsThe ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1‐SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], −0.03 [−0.04 to −0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], −0.02 [−0.03 to −0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], −0.04 [−0.06 to −0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5.ConclusionsGreater visit‐to‐visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long‐Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study

Yano

Griswold

Wang

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Based on observational data, an increase in BP of 20 mm Hg systolic or 10 mm Hg diastolic is associated with a doubling of the risk of CVD death, regardless of age 5. Further, hypertension in middle age is known to increase the risk of chronic kidney disease (CKD) and dementia in later life, an important issue given the aging demographic in Western societies 6. Finally, despite the fact that BP recognition and control are improving, it is concerning that nearly half of the hypertensive population remains suboptimally controlled 2…”

Section: Introductionmentioning

confidence: 99%