Summary: High blood pressure during your 30s increases the risk of dementia and cognitive decline later in life. Treating hypertension early can help to prevent dementia and Alzheimers disease in your 70s.

Source: UC Davis

Having high blood pressure in your 30s is associated with worse brain health around age 75, especially for men, according to a new UC Davis study.

The research,published this weekinJAMA Network Open, compared magnetic resonance imaging (MRI) brain scans of older adults who had high blood pressure between the ages of 30 to 40 with older adults who had normal blood pressure.

The researchers found that the high blood pressure group had significantly lower regional brain volumes and worse white matter integrity. Both factors are associated with dementia.

The research also showed that the negative brain changes in some regions such as decreased grey matter volume and frontal cortex volume were stronger in men. They note the differences may be related to the protective benefits of estrogen before menopause.

Treatment for dementia is extremely limited, so identifying modifiable risk and protective factors over the life course is key to reducing disease burden, said first authorKristen M. George, an assistant professor in theDepartment of Public Health Sciences.

High blood pressure is an incredibly common and treatable risk factor associated with dementia. This study indicates hypertension status in early adulthood is important for brain health decades later, George said.

High blood pressure, also known as hypertension, is blood pressure that is higher than normal. A normal blood pressure level is less than 130/80 mmHg. The Centers for Disease Control and Prevention estimates that47% of adultsin the United States have hypertension.

The rate of high blood pressure varies by sex and race. About 50% of men have high blood pressure compared to 44% of women. The rate of hypertension is about 56% in Black adults, 48% in white adults, 46% in Asian adults and 39% in Hispanic adults. African Americans ages 35 to 64 years are50% more likelyto have high blood pressure than whites.

The researchers looked at data from 427 participants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the Study of Healthy Aging in African Americans (STAR). This provided them with health data from 1964 to 1985 for a diverse cohort of older Asian, Black, Latino and white adults.

They obtained two blood pressure readings from when the participants were between the ages of 30 to 40. This allowed them to determine if they had been hypertensive, transitioning to hypertensive or had normal blood pressure in young adulthood.

MRI scans of the participants conducted between 2017 and 2022 allowed them to look for late-life neuroimaging biomarkers of neurodegeneration and white matter integrity.

A significant reduction in cerebral gray matter volume is seen in both men and women with hypertension but is stronger in men.

Compared to participants with normal blood pressure, the brain scans of those transitioning to high blood pressure or with high blood pressure showed lower cerebral gray matter volume, frontal cortex volume and fractional anisotropy (a measure of brain connectivity). The scores for men with high blood pressure were lower than those for women.

The study joins a growing body of evidence that cardiovascular risk factors in young adulthood are detrimental to late-life brain health.

The researchers note that due to the sample size, they could not examine racial and ethnic differences and recommended interpreting results regarding sex differences with caution. They also note that the MRI data was only available from one time-point late in life. This can only determine physical properties like volumetric differences, not specific evidence of neurodegeneration over time.

This study truly demonstrates the importance of early life risk factors, and that to age well, you need to take care of yourself throughout life heart health is brain health, saidRachel Whitmer, senior author of the study. Whitmer is a professor in the departments ofPublic Health SciencesandNeurologyand chief of theDivision of Epidemiology. Shes also the associate director of theUC Davis Alzheimers Disease Center.

We are excited to be able to continue following these participants and to uncover more about what one can do in early life to set yourself up for healthy brain aging in late life, Whitmer said.

Additional authors of the study include Pauline Maillard, Evan Fletcher, Dan M. Mungas and Charles DeCarli, UC Davis; Paola Gilsanz, Kaiser Permanente Division of Research; Rachel L. Peterson, University of Montana, Missoula; Joseph Fong and Elizabeth Rose Mayeda from UCLA; L. Barnes from Rush Medical College; M. Maria Glymour from UCSF.

Author: Lisa HowardSource: UC DavisContact: Lisa Howard UC DavisImage: The image is in the public domain

Original Research: Open access.Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers by Kristen M. George et al. JAMA Network Open

Abstract

Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers

Importance

The association between hypertension developed before midlife and late-life brain health is understudied and, because of the cardioprotective benefits of estrogen before menopause, may differ by sex.

Objective

To assess the association of early adulthood hypertension and blood pressure (BP) change with late-life neuroimaging biomarkers and examine potential sex differences.

Design, Setting, and Participants

This cohort study used data from the Study of Healthy Aging in African Americans (STAR) and Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, which were harmonized longitudinal cohorts of racially and ethnically diverse adults aged 50 years and older from the San Francisco Bay area and Sacramento Valley in California. The STAR was conducted from November 6, 2017, to November 5, 2021, and the KHANDLE study was conducted from April 27, 2017, to June 15, 2021. The current study included 427 participants from the KHANDLE and STAR studies who received health assessments between June 1, 1964, and March 31, 1985. Regional brain volumes and white matter (WM) integrity were measured via magnetic resonance imaging between June 1, 2017, and March 1, 2022.

Exposures

Hypertension status (normotension, transition to hypertension, and hypertension) and BP change (last measure minus first measure) were assessed at 2 multiphasic health checkups (MHCs; 1964-1985) in early adulthood (ages 30-40 years).

Main Outcomes and Measures

Regional brain volumes and WM integrity were measured using 3T magnetic resonance imaging andzstandardized. General linear models adjusted for potential confounders (demographic characteristics and study [KHANDLE or STAR]) were used to assess the association of hypertension and BP change with neuroimaging biomarkers. Sex interactions were tested.

Results

Among 427 participants, median (SD) ages were 28.9 (7.3) years at the first MHC, 40.3 (9.4) years at the last MHC, and 74.8 (8.0) years at neuroimaging. A total of 263 participants (61.6%) were female and 231 (54.1%) were Black. Overall, 191 participants (44.7%) had normotension, 68 (15.9%) transitioned to hypertension, and 168 (39.3%) had hypertension.

Compared with participants who had normotension, those who had hypertension and those who transitioned to hypertension had smaller cerebral volumes (hypertension: =0.26 [95% CI, 0.41 to 0.10]; transition to hypertension: =0.23 [95% CI, 0.44 to 0.23]), with similar differences in cerebral gray matter volume (hypertension: =0.32 [95% CI, 0.52 to 0.13]; transition to hypertension: =0.30 [95% CI, 0.56 to 0.05]), frontal cortex volume (hypertension: =0.43 [95% CI, 0.63 to 0.23]; transition to hypertension: =0.27 [95% CI, 0.53 to 0]), and parietal cortex volume (hypertension: =0.22 [95% CI, 0.42 to 0.02]; transition to hypertension: =0.29 [95% CI, 0.56 to 0.02]). Participants with hypertension also had smaller hippocampal volume (=0.22; 95% CI, 0.42 to 0.02), greater ventricular volumes (lateral ventricle: =0.44 [95% CI, 0.25-0.63]; third ventricle: =0.20 [95% CI, 0.01-0.39]), larger free water volume (=0.35; 95% CI, 0.18-0.52), and lower fractional anisotropy (=0.26; 95% CI, 0.45 to 0.08) than those who had normotension.

Holding hypertension status constant, a 5-mm Hg increase in systolic BP was associated with smaller temporal cortex volume (=0.03; 95% CI, 0.06 to 0.01), while a 5-mm Hg increase in diastolic BP was associated with smaller parietal cortex volume (=0.06; 95% CI, 0.10 to 0.02). The negative association of hypertension and BP change with regional brain volumes appeared stronger in men than women for some regions.

Conclusions and Relevance

In this cohort study, early adulthood hypertension and BP change were associated with late-life volumetric and WM differences implicated in neurodegeneration and dementia. Sex differences were observed for some brain regions whereby hypertension and increasing BP appeared more detrimental for men. These findings suggest that prevention and treatment of hypertension in early adulthood is important for late-life brain health, particularly among men.

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