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.
We hypothesized that in participants with a history of hypertension, lower late-life blood pressure (BP) will be associated with more brain pathology.
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.
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.
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.