- Sustained hypertension from mid- to late life is linked to increased risk for incident dementia.
- A pattern of midlife hypertension and late-life hypotension is also linked to increased risk.
Why this matters
- Editorial: many questions remain, and uncertainties persist about what to do for patients without symptoms but with moderate-severe white matter disease on imaging, for example.
- Current guidelines certainly support managing risk factors, but BP targets in this group are unclear, the editorial says.
- Dementia incidence rates (95% CIs) per 100 person-years with:
- Mid-/late-life normotension: 1.31 (1.00-1.72);
- Midlife normotension/late-life hypertension: 1.99 (1.69-2.32);
- Mid-/late-life hypertension: 2.83 (2.40-3.35);
- Midlife normotension/late-life hypotension: 2.07 (1.68-2.54); and
- Midlife hypertension/late-life hypotension: 4.26 (3.40-5.32).
- Vs normotensive BP throughout, HRs (95% CIs) for dementia:
- 1.49 (1.06-2.08) with mid-/late-life hypertension; and
- 1.62 (1.11-2.37) with midlife hypertension, late-life hypotension.
- Sustained midlife hypertension was tied to increased dementia risk regardless of late-life status: HR, 1.41 (95% CI, 1.17-1.71).
- Prospective, population-based Atherosclerosis Risk in Communities study; 4761 people enrolled in midlife (1987-1989, first visit), followed for 6 visits, 2016-2017.
- Hypertension: >140/90 mmHg; hypotension:
- Primary outcome: dementia onset based on screening, codes, questionnaires.
- Funding: NIH.
- Increased likelihood of dropout with higher BP, poorer cognition.
- Dementia aetiology unknown.