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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Late-Life Blood Pressure and Cerebral Amyloid Angiopathy: Findings from the U.S. National Alzheimer's Coordinating
Mo-Kyung Sin1, N Maritza Dowling2,3, Jeffrey M Roseman4
1College of Nursing, Seattle University, Seattle, WA 98122, USA.
Insights
This study found no link between high blood pressure and cerebral amyloid angiopathy (CAA). Further research is needed to understand their relationship and impact on brain health.
Area of Science:
- Neurology
- Pathology
- Epidemiology
Background:
- High blood pressure (BP) and cerebral amyloid angiopathy (CAA) are risk factors for intracranial hemorrhage and cognitive decline.
- The relationship between BP and CAA requires further investigation.
Purpose of the Study:
- To examine the association between longitudinal systolic blood pressure (SBP) and the severity of cerebral amyloid angiopathy (CAA).
Main Methods:
- Analysis of data from 2510 participants in the National Alzheimer's Coordinating Center (NACC).
- Categorization of SBP into three groups (<120 mmHg, 120-139 mmHg, ≥140 mmHg) based on longitudinal measurements before death.
- Assessment of CAA severity using post-mortem immunohistochemistry.
Main Results:
- No significant association was found between SBP categories and the odds of CAA after adjusting for multiple covariates.
- Predictor effect plots indicated no variation in CAA probability across SBP categories.
- While microbleeds showed no direct association with CAA, a trend suggested a higher proportion of microbleeds in severe CAA cases among individuals with SBP ≥ 130 mmHg.
Conclusions:
- The study found no evidence supporting an association between systolic blood pressure and cerebral amyloid angiopathy.
- Future research should focus on developing non-invasive diagnostic tests for CAA and prospectively examining its association with BP and implications for Alzheimer's disease pathophysiology.
Abstract:
High blood pressure (BP) and cerebral amyloid angiopathy (CAA) are two common risk factors for intracranial hemorrhage, potentially leading to cognitive impairment. Less is known about the relationship between BP and CAA, the examination of which was the objective of this study. We analyzed data from 2510 participants in the National Alzheimer's Coordinating Center (NACC) who had information on longitudinal BP measurements before death and on CAA from autopsy. Using the average of four systolic BPs (SBPs) prior to death, SBP was categorized into three groups: <120 mmHg (n = 435), 120-139 mmHg (n = 1335), and ≥140 mmHg (n = 740). CAA was diagnosed using immunohistochemistry in 1580 participants and categorized as mild (n = 759), moderate (n = 529), or severe (n = 292). When adjusted for age at death, sex, APOE genotype, Braak, CERAD, antihypertensive medication use, and microinfarcts, the odds ratios (95% CIs) for CAA associated with SBPs of 120-139 and ≥140 mmHg were 0.91 (0.74-1.12) and 1.00 (0.80-1.26), respectively. Findings from predictor effect plots show no variation in the probability of CAA between the three SBP categories. Microbleeds had no association with CAA, but among those with SBP ≥ 130 mmHg, the proportion of those with microbleeds was numerically greater in those with more severe CAA (p for trend, 0.084). In conclusion, we found no evidence of an association between SBP and CAA. Future studies need to develop non-invasive laboratory tests to diagnose CAA and prospectively examine this association and its implication on the pathophysiology and outcome of Alzheimer's disease.
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