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Abstract
Objective: We hypothesized that in participants with a history of hypertension, lower late-life blood pressure (BP) will be associated with more brain pathology.
Methods: Participants are 4,057 older men and women without dementia with midlife (mean age 50 ± 6 years) and late-life (mean age 76 ± 5 years) vascular screening, cognitive function, and brain structures on MRI ascertained as part of the Age, Gene/Environment Susceptibility (AGES)–Reykjavik Study.
Results: The association of late-life BP to brain measures depended on midlife hypertension history. Higher late-life systolic and diastolic BP (DBP) was associated with an increased risk of white matter lesions and cerebral microbleeds, and this was most pronounced in participants without a history of midlife hypertension. In contrast, in participants with a history of midlife hypertension, lower late-life DBP was associated with smaller total brain and gray matter volumes. This finding was reflected back in cognitive performance; in participants with midlife hypertension, lower DBP was associated with lower memory scores.
Conclusion: In this large population-based cohort, late-life BP differentially affects brain pathology and cognitive performance, depending on the history of midlife hypertension. Our study suggests history of hypertension is critical to understand how late-life BP affects brain structure and function.
GLOSSARY
- AGES-Reykjavik Study=
- Age, Genee/Environment Susceptibility–Reykjavik Study;
- ANCOVA=
- analysis of covariance;
- BMI=
- body mass index;
- BP=
- blood pressure;
- CI=
- confidence interval;
- DBP=
- diastolic blood pressure;
- FLAIR=
- fluid-attenuated inversion recovery;
- GM=
- gray matter;
- GMV=
- gray matter volume;
- ICD-10=
- International Classification of Diseases-10;
- ICV=
- intracranial volume;
- PP=
- pulse pressure;
- SBP=
- systolic blood pressure;
- TBV=
- total brain volume;
- WM=
- white matter;
- WML=
- white matter lesions;
- WMV=
- white matter volume
Footnotes
Coinvestigators are listed on the Neurology® Web site at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received July 19, 2013.
- Accepted in final form March 18, 2014.
- © 2014 American Academy of Neurology
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