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June 17, 2014; 82 (24) Article

Joint effect of mid- and late-life blood pressure on the brain

The AGES-Reykjavik Study

Majon Muller, Sigurdur Sigurdsson, Olafur Kjartansson, Thor Aspelund, Oscar L. Lopez, Palmi V. Jonnson, Tamara B. Harris, Mark van Buchem, Vilmundur Gudnason, Lenore J. Launer, For the Age, Gene/Environment Susceptibility-Reykjavik Study Investigators
First published June 4, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000517
Majon Muller
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Sigurdur Sigurdsson
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Olafur Kjartansson
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Thor Aspelund
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Oscar L. Lopez
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Palmi V. Jonnson
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Tamara B. Harris
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Mark van Buchem
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Vilmundur Gudnason
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Lenore J. Launer
From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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From the Laboratory of Epidemiology and Population Sciences (M.M., T.B.H., L.J.L.), Intramural Research Program, National Institute on Aging, Bethesda, MD; the Departments of Gerontology and Geriatrics (M.M.) and Radiology (M.v.B.), Leiden University Medical Center; Icelandic Heart Association (S.S., O.K., T.A., V.G.), Kopovagur; the Departments of Neurology & Radiology (O.K.) and Geriatrics (P.V.J.), Landspitali National University Hospital, Reykjavik, Iceland; the Department of Neurology (O.L.L.), University of Pittsburgh, PA; and the Faculty of Medicine (P.V.J.), University of Iceland, Reykjavik.
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Joint effect of mid- and late-life blood pressure on the brain
The AGES-Reykjavik Study
Majon Muller, Sigurdur Sigurdsson, Olafur Kjartansson, Thor Aspelund, Oscar L. Lopez, Palmi V. Jonnson, Tamara B. Harris, Mark van Buchem, Vilmundur Gudnason, Lenore J. Launer, For the Age, Gene/Environment Susceptibility-Reykjavik Study Investigators
Neurology Jun 2014, 82 (24) 2187-2195; DOI: 10.1212/WNL.0000000000000517

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This article has a correction. Please see:

  • Joint effect of mid- and late-life blood pressure on the brain: The AGES-Reykjavik Study - August 26, 2014
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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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Disputes & Debates: Rapid online correspondence

  • Reply to Kowal and Charlton
    • Majon Muller, Associate Professor of Internal and Geriatric Medicine, Leiden Univeristy Medical Centerm.muller@lumc.nl
    • Majon Muller, Leiden, The Netherlands; Lenore Launer, Bethesda, MD
    Submitted July 18, 2014
  • Midlife and older adulthood diabetes and hypertension may affect cognition later in life in more and less wealthy countries alike
    • Paul Kowal, Scientist, World Health Organization's SAGEkowalp@who.int
    • Karen Charlton, University of Wollongong, NSW, Australia.
    Submitted July 10, 2014
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