Study: High blood pressure in midlife increases risk of cognitive decline later

Findings suggest treating hypertension could preserve cognitive function

Data from a long-term study of thousands of Americans suggests that a history of high blood pressure in midlife increases the risk of cognitive decline in old age, Johns Hopkins researchers say.

The findings, the scientists say, indicate a treatable cause—hypertension—for at least some pervasive forms of cognitive deficit.

Alzheimer's disease and other forms of dementia affect more than 35 million people around the world, according to the World Health Organization. Despite the persistent nature of the problem, no truly effective treatment exists.

Previous research suggests that vascular disease, already known to cause heart attacks and strokes, also contributes to dementia's pathology. But researchers are still unclear about the details of this association and whether treatments that target high blood pressure might also help prevent dementia, says study leader says Rebecca F. Gottesman, an associate professor of neurology and epidemiology at the Johns Hopkins University School of Medicine.

To investigate, Gottesman and her colleagues used data from the Atherosclerosis Risk in Communities (ARIC) study, a long-term study started in the late 1980s that has followed more than 15,000 adults over 25 years. The ARIC study, originally designed to track how risk factors for atherosclerosis—hardening and narrowing of the arteries—might lead to later cardiovascular disease, has also included assessments of the volunteers' cognitive skills over the years, a window into cognitive change.

The researchers have used this information to investigate how blood pressure measurements taken five times over the course of ARIC—the first taken when subjects were between 48 and 67 years old—correlated with the results of three cognitive tests participants took several times over the course of the study period. Their findings, published in the Aug. 4 issue of JAMA Neurology, showed that even though all the participants had some cognitive decline over time (an inevitable part of old age), those who had hypertension in those first blood pressure readings during midlife had a 6.25 percent steeper decline than those whose blood pressure readings were normal.

"It may not seem like a huge effect, but that's just the average amount of cognitive decline," Gottesman says. "Some people probably have a significantly larger amount of decline. Since the number of people with hypertension is huge on a population scale, that leads to a lot of people with hypertension-related dementia."

The good news, Gottesman says, is that at least some of the decline may be preventable by controlling blood pressure early. The team's results also showed that ARIC participants who took blood pressure-lowering drugs had less cognitive decline than those whose high blood pressure was uncontrolled—another reason to aggressively treat hypertension, particularly in middle age.

"The take-home message is that we need to pay attention to hypertension at a relatively young age, long before the health problems of old age set in," Gottesman says. "People should really know what their blood pressure is and what their doctor plans to do if it's elevated."

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