Blood pressure screening in midlife aids in prediction of dementia later in life

Keywords: midlife hypertension, screening, dementia, prediction, long-term follow-up, prevalence

Abstract

Background: There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer’s disease (AD), or vascular dementia (VaD) later in life.

Methods: The community-based study population comprised 30,102 dementia-free individuals from the Westmannia Cardiovascular Risk Factors Study. The participants were aged 40 or 50 years when the health examination took place in 1990–2000. Diagnose registers from both hospitals and primary healthcare centers were used to identify individuals who after inclusion to the study developed dementia. The association between midlife high blood pressure (defined as systolic blood pressure >140 and/or diastolic blood pressure >90 mmHg) at a single timepoint and dementia was adjusted for age, gender, body mass index (BMI), fasting blood glucose, education, smoking, and physical activity level. Multivariate binary cox regression analyses were used.

Results: After a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.02–1.45) and VaD (HR: 2.10, 95% CI: 1.47–3.00) but not AD (HR: 1.06, 95% CI: 0.81–1.38).

Conclusion: This study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment.

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References


  1. World Alzheimer Report 2018 – the state of the art of dementia research: new frontiers. Alzheimer’s Disease International; 2018 Available from: https://www.alzint.org/u/WorldAlzheimerReport2018.pdf [cited 23 March 2020].

  2. Barnes DE, Yaffe K. The projected impact of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011;10:819–28. doi: 10.1016/S1474-4422(11)70072-2

  3. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol. 2014;13:788–94. doi: 10.1016/S1474-4422(14)70136-X

  4. G8 dementia summit: global action against dementia – 11 December 2013. GOV.UK. Available from: https://www.gov.uk/government/publications/g8-dementia-summit-global-action-against-dementia/g8-dementia-summit-global-action-against-dementia-11-december-2013 [cited 20 March 2020].

  5. Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, et al. Impact of hypertension on cognitive function. Hypertension. 2016;68:e67–94. doi: 10.1161/HYP.0000000000000053

  6. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–734. doi: 10.1016/S0140-6736(17)31363-6

  7. Toledo JB, Arnold SE, Raible K, Brettschneider J, Xie SX, Grossman M, et al. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer’s Coordinating Centre. Brain. 2013;136:2697–706. doi: 10.1093/brain/awt188

  8. Hughes D, Judge C, Murphy R, Loughlin E, Costello M, Whiteley W, et al. Association of blood pressure lowering with incident dementia or cognitive impairment: a systematic review and meta-analysis. JAMA. 2020;323:1934. doi: 10.1001/jama.2020.4249

  9. Tzourio C. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163:1069–75. doi: 10.1001/archinte.163.9.1069

  10. Forette F, Seux M-L, Staessen JA, Thijs L, Birkenhäger WH, Babarskiene M-R, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998;352:1347–51. doi: 10.1016/S0140-6736(98)03086-4

  11. Kivipelto M, Helkala E-L, Hanninen T, Laakso MP, Hallikainen M, Alhainen K, et al. Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology. 2001;56:1683–9. doi: 10.1212/WNL.56.12.1683

  12. Lane CA, Barnes J, Nicholas JM, Sudre CH, Cash DM, Parker TD, et al. Associations between blood pressure across adulthood and late-life brain structure and pathology in the neuroscience substudy of the 1946 British birth cohort (Insight 46): an epidemiological study. Lancet Neurol. 2019;18:942–52. doi: 10.1016/S1474-4422(19)30228-5

  13. Launer LJ, Ross GW, Petrovitch H, Masaki K, Foley D, White LR, et al. Midlife blood pressure and dementia: the Honolulu–Asia aging study☆. Neurobiol Aging. 2000;21:49–55. doi: 10.1001/jama.2013.284427

  14. Kilander L, Nyman H, Boberg M, Hansson L, Lithell H. Hypertension is related to cognitive impairment. Hypertension. 1998;31:780–6. doi: 10.1161/01.HYP.31.3.780

  15. McGrath ER, Beiser AS, DeCarli C, Plourde KL, Vasan RS, Greenberg SM, et al. Blood pressure from mid‐ to late life and risk of incident dementia. Neurology. 2017;89:2447–54. doi: 10.1212/WNL.0000000000004741

  16. Gottesman RF, Albert MS, Alonso A, Coker LH, Coresh J, Davis SM, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort. JAMA Neurol. 2017;74:1246. doi: 10.1001/jamaneurol.2017.1658

  17. Whitmer RA, Sidney S, Selby J, Johnston SC, Yaffe K. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology. 2005;64:277–81. doi: 10.1212/01.WNL.0000149519.47454.F2

  18. Andersson P, Sjöberg RL, Öhrvik J, Leppert J. Knowledge about cardiovascular risk factors among obese individuals. Eur J Cardiovasc Nurs. 2006;5:275–9. doi: 10.1016/j.ejcnurse.2006.02.005

  19. Ritz K, Denswil NP, Stam OCG, van Lieshout JJ, Daemen MJAP. Cause and mechanisms of intracranial atherosclerosis. Circulation. 2014;130:1407–14. doi: 10.1161/CIRCULATIONAHA.114.011147

  20. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MMB. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215–22. doi: 10.1056/NEJMoa022066

  21. Pohjasvaara T, Erkinjuntti T, Ylikoski R, Hietanen M, Vataja R, Kaste M. Clinical determinants of poststroke dementia. Stroke. 1998;29:75–81. doi: 10.1161/01.STR.29.1.75

  22. Gao Z, Wang W, Wang Z, Zhao X, Shang Y, Guo Y, et al. Cerebral microbleeds are associated with deep white matter hyperintensities, but only in hypertensive patients. PLoS One. 2014;9:91637. doi: 10.1371/journal.pone.0091637

  23. Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community- dwelling older persons. Neurology. 2007;69:2197–204. doi: 10.1212/01.wnl.0000271090.28148.24

  24. Williams B, Mancia G, Rosei EA, Azizi M, Burnier M, Clement DL, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;00:1–98. doi: 10.1093/eurheartj/ehy339

  25. Rönnemaa E, Zethelius B, Lannfelt L, Kilander L. Vascular risk factors and dementia: 40-year follow-up of a population-based cohort. Dement Geriatr Cogn Disord. 2011;31:460–6. doi: 10.1159/000330020

  26. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim J-L, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi: 10.1186/1471-2458-11-450

  27. Dahl A, Berg S, Nilsson SE. Identification of dementia in epidemiological research: a study on the usefulness of various data sources. Aging Clin Exp Res. 2007;19:381–9. doi: 10.1007/BF03324718

  28. Edhag O, Statens beredning för medicinsk utvärdering. Sammanfattning av SBU:s rapport om Demenssjukdomar en systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2006. Available from: http://www.sbu.se/upload/Publikationer/Content0/1/Demens_sammanfattning.pdf [cited 23 March 2020].

Published
2022-01-03
How to Cite
Linn Moberg, LeppertJ., Simon Liljeström, Mattias Rehn, KilanderL., & Abbas Chabok. (2022). Blood pressure screening in midlife aids in prediction of dementia later in life. Upsala Journal of Medical Sciences, 127(1). https://doi.org/10.48101/ujms.v127.7860