Mid- to late-life BP patterns associated with dementia risk

  • JAMA

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 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.

Limitations

  • Increased likelihood of dropout with higher BP, poorer cognition.
  • Dementia aetiology unknown.