Hypertension Speeds Cognitive Decline Later in Life

An observational study led by researchers from Johns Hopkins University finds that hypertension in middle age could speed up cognitive decline over the following 20 years.

The data “suggest that elevated blood pressure in midlife is an important risk factor for cognitive decline later in life,” says Rebecca Gottesman, MD, PhD, an associate professor of neurology and epidemiology at Johns Hopkins University, and lead author of the study. “This suggests that primary care doctors should be monitoring blood pressure in their patients and considering treatment when it is elevated.”
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In the study, Gottesman and colleagues observed 13,476 participants in the Atherosclerosis Risk in Communities (ARIC) study, following for blood pressure, standardized cognitive assessment performance, and covariates. The investigators found that high blood pressure at baseline in this group, aged 48 to 67, was associated with 0.056 z score-points more decline in global cognition over 2 decades of follow-up than seen with normal blood pressure at baseline, which represented a “relatively modest” 6.5 percent great decline than expected from aging alone, according to the authors.

The researchers also noted that individuals medically treated for hypertension had a significantly smaller decline of 0.050 global z score points, in comparison to 0.079 among people with untreated hypertension over the 20-year follow-up period. Blood pressure at the end of the study wasn't significantly linked to cognitive decline over the prior 20 years, an association that was greater in whites than African Americans.

Identifying midlife hypertension as a critical risk factor for cognitive decline “yields a potential treatable target, with the recognition that treatment might need to be implemented for decades," the researchers noted.

“In general, I suspect that the problem from hypertension is not that primary care doctors are not treating it, but rather that many people are not going to the doctor or having it checked at all,” says Gottesman. “In addition, however, our data suggest that waiting to treat hypertension until later in life might not be a good idea—it may be too late to reduce the potential cognitive decline associated with the hypertension.”

—Mark McGraw

Reference

Gottesman R, Schneider A, et al. Midlife Hypertension and 20-Year Cognitive Change. The Atherosclerosis Risk in Communities Neurocognitive Study. JAMA Neurol. 2014.