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Beyond Hypertension: Examining Variable Blood Pressure's Role in Cognition and Brain Structure
Cassandra Morrison1, Michael D Oliver2,3, Farooq Kamal4,5
1Department of Psychology, Carleton University, Ottawa, Ontario, Canada.
Insights
Variable blood pressure (BP) is linked to faster cognitive decline and greater brain changes than high BP. Managing variable BP may help prevent dementia in older adults.
Area of Science:
- Neurology
- Gerontology
- Cardiovascular Health
Background:
- Hypertension is a modifiable risk factor for dementia, contributing to 40% of cases.
- While hypertension is linked to cognitive decline and brain changes, the long-term effects of blood pressure variability are less understood.
Purpose of the Study:
- To investigate the association between variable blood pressure (BP) and longitudinal changes in cognition, brain structure (white matter hyperintensities, gray matter, and white matter volume), and postmortem neuropathology.
- To compare the effects of normal, high, and variable BP on cognitive and brain health over time.
Main Methods:
- Analysis of 4,606 participants from RADC RUSH and 2,114 from ADNI, with a total of 42,603 follow-ups.
- Participants categorized into normal, high, or variable BP groups.
- Linear-mixed models used to assess relationships between BP, cognition, brain structure, and neuropathology.
Main Results:
- Older adults with variable BP showed the most rapid cognitive decline, followed by high BP, then normal BP.
- Variable BP was associated with increased gray matter volume loss and white matter hyperintensity burden compared to high and normal BP.
- Postmortem analysis revealed higher neuropathology rates in both variable and high BP groups versus normal BP.
Conclusions:
- Variable BP may diminish resilience to dementia-related pathology and poses a greater dementia risk than high BP alone.
- Effective management of variable BP is crucial for reducing cognitive decline in the elderly population.
- Findings were consistent across both study cohorts, indicating generalizability.
Objectives:
Hypertension or high blood pressure (BP) is one of the 12 modifiable risk factors that contribute to 40% of dementia cases that could be delayed or prevented. Although hypertension is associated with cognitive decline and structural brain changes, less is known about the long-term association between variable BP and cognitive/brain changes. This study examined the relationship between variable BP and longitudinal cognitive, white matter hyperintensity (WMH), gray matter (GM), and white matter (WM) volume change over time and postmortem neuropathology.
Methods:
A total of 4,606 participants (32,776 follow-ups) from RADC Research Resource Sharing Hub (RUSH) and 2,114 participants (9,827 follow-ups) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were included. Participants were divided into 1 of 3 groups: normal, high, or variable BP. Linear-mixed models investigated the relationship between BP and cognition, brain structure, and neuropathology.
Results:
Older adults with variable BP exhibited the highest rate of cognitive decline followed by high and then normal BP. Increased GM volume loss and WMH burden were also observed in variable compared to high and normal BP. In postmortem neuropathology, both variable and high BP had increased rates compared to normal BP. Results were consistent across the RUSH and ADNI participants, supporting the generalizability of the findings.
Discussion:
Damages potentially associated with variable BP may reduce resilience to future dementia-related pathology and increased the risk of dementia more than that caused by high BP. Improved treatment and management of variable BP may help reduce cognitive decline in the older adult population.
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