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Change in blood pressure and incident dementia: a 32-year prospective study

Robert Stewart1, Qian-Li Xue, Kamal Masaki

  • 1Section of Epidemiology (Box 60), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom. r.stewart@iop.kcl.ac.uk

Hypertension (Dallas, Tex. : 1979)
|July 1, 2009
PubMed

Insights

Men who developed dementia showed a significant increase and subsequent decrease in systolic blood pressure (BP) over 32 years. Antihypertensive medication modified these long-term BP trends in relation to dementia risk.

Area of Science:

  • Gerontology
  • Cardiovascular Health
  • Neurology

Background:

  • Inconsistent findings exist regarding the association between high blood pressure (BP) and dementia.
  • Understanding long-term BP trajectories in relation to dementia development is crucial.

Purpose of the Study:

  • To investigate the association between long-term systolic blood pressure (SBP) and diastolic blood pressure (DBP) trajectories and incident dementia.
  • To explore how antihypertensive medication influences these associations.

Main Methods:

  • Analysis of 1890 Japanese American men from the Honolulu Heart Program/Honolulu-Asia Aging Study over an average of 32 years.
  • Systolic and diastolic BP measured at 6 examinations; dementia assessed at the final 3 examinations.
  • Repeated-measures analysis with splines to estimate BP trajectories and their association with incident dementia.

Main Results:

  • Men who developed dementia exhibited an additional age-adjusted annual SBP increase of 0.26 mm Hg and a later decline of 1.36 mm Hg compared to those without dementia.
  • These SBP trends were most pronounced for vascular dementia and were reduced by antihypertensive medication.
  • Similar DBP changes were observed for vascular dementia, unaffected by antihypertensive treatment.

Conclusions:

  • Long-term systolic blood pressure shows distinct patterns in individuals who develop dementia, characterized by an initial rise followed by a subsequent fall.
  • Antihypertensive therapy appears to modify the relationship between systolic BP trajectories and dementia risk.
  • The findings highlight the complex interplay between blood pressure management and dementia prevention over the lifespan.

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