Midlife hypertension or increasing blood pressure is associated with an increase in white matter hyperintensity volume and smaller brain volumes in older adults aged 69 to 71 years, according to study results published in Lancet Neurology. There was no evidence suggesting a link between blood pressure and cognition or cerebral amyloid-β load in this age group.

A team of UK-based investigators included participants from Insight 46, a substudy of the Medical Research Council National Survey of Health and Development, in their analysis. Participants were between age 69 and 71 years, did not have dementia at baseline, and received T1 and FLAIR volumetric magnetic resonance imaging, florbetapir amyloid-positron emission tomography imaging, and cognitive assessment. Using data from Insight 46, the researchers compiled participant blood pressure readings that had been collected at age 36, 43, 53, 60 to 64, and 69 years.

The primary outcomes were white matter hyperintensity volume, amyloid-β positivity or negativity, whole-brain and hippocampal volumes, and composite cognitive score.

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A total of 465 individuals (51% men; average age, 70.7 years; 18% amyloid-β positive) were included in the imaging analyses.

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Higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) at age 53 years and greater increases in SBP and DBP from age 43 to 53 years were positively correlated with white matter hyperintensity volume at age 69 to 71 years. A higher DBP between age 36 and 43 years was linked to a smaller whole-brain volume at 69 to 71 years, while higher SBP between the same ages was associated with smaller volumes of the hippocampus. No associations between changes in blood pressure and amyloid-β status or composite cognitive score were reported.

“Based on our results, the fourth to sixth decades of life might be a sensitive period when changes in blood pressure are particularly damaging to the brain,” the authors noted. “Findings suggest that routine and serial blood pressure measurement might need to start earlier than is typically considered (eg, around 40 years of age), and decisions to start treatment might need to be based not only on absolute blood pressure, but also longitudinal blood pressure change.”

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Lane CA, Barnes J, Nicholas JM, et al. Associations between blood pressure across adulthood and late-life brain structure and pathology in the neuroscience substudy of the 1946 British birth cohort (Insight 46): an epidemiological study [published online August 20, 2019]. Lancet Neurol. doi:10.1016/s1474.4422(19)3028-5