Midlife hypertension and 20-year cognitive change

The atherosclerosis risk in communities neurocognitive study

Rebecca F Gottesman, Andrea L C Schneider, Marilyn Albert, Alvaro Alonso, Karen J Bandeen Roche, Laura Coker, Josef Coresh, David Knopman, Melinda C. Power, Andreea Rawlings, A. Richey Sharrett, Lisa M. Wruck, Thomas H. Mosley

Research output: Contribution to journalArticle

Abstract

IMPORTANCE Hypertension is a treatable potential cause of cognitive decline and dementia, but its greatest influence on cognition may occur in middle age.

OBJECTIVE To evaluate the association between midlife (48-67 years of age) hypertension and the 20-year change in cognitive performance.

Design, Setting, and Participants The Atherosclerosis Risk in Communities cohort (1990-1992 through 2011-2013) underwent evaluation at field centers inWashington County, Maryland, Forsyth County, North Carolina, Jackson, Mississippi, and the Minneapolis, Minnesota, suburbs. Of 13 476 African American and white participants with baseline cognitive data, 58.0%of living participants completed the 20-year cognitive follow-up.

Exposures Hypertension, prehypertension, or normal blood pressure (BP) at visit 2 (1990-1992) constituted the primary exposure. Systolic BP at visit 2 or 5 (2011-2013) and indication for treatment at visit 2 based on the Eighth Joint National Committee (JNC-8) hypertension guidelines constituted the secondary exposures.

Main Outcomes and Measures Prespecified outcomes included the 20-year change in scores on the DelayedWord Recall Test, Digit Symbol Substitution Test, andWord Fluency Test and in global cognition.

Results During 20 years, baseline hypertension was associated with an additional decline of 0.056 global z score points (95%CI, -0.100 to -0.012) and prehypertension was associated nonsignificantly with 0.040 more global z score points of decline (95%CI, -0.085 to 0.005) compared with normal BP. Individuals with hypertension who used antihypertensives had less decline during the 20 years than untreated individuals with hypertension (-0.050 [95% CI, -0.003 to -0.097] vs -0.079 [95%CI, -0.156 to -0.002] global z score points). Having a JNC-8-specified indication for initiating antihypertensive treatment at baseline was associated with a greater 20-year decline (-0.044 [95%CI, -0.085 to -0.003] global z score points) than not having an indication.We observed effect modification by race for the continuous systolic BP analyses (P = .01), with each 20-mm Hg increment at baseline associated with an additional decline of 0.048 (95%CI, -0.074 to -0.022) points in global cognitive z score in whites but not in African Americans (decline, -0.020 [95%CI, -0.026 to 0.066] points). Systolic BP at the end of follow-up was not associated with the preceding 20 years of cognitive change in either group.Methods to account for bias owing to attrition strengthened the magnitude of some associations.

Conclusions and Relevance Midlife hypertension and elevated midlife but not late-life systolic BP was associated with more cognitive decline during the 20 years of the study. Greater decline is found with higher midlife BP in whites than in African Americans.

Original languageEnglish (US)
Pages (from-to)1218-1227
Number of pages10
JournalJAMA Neurology
Volume71
Issue number10
DOIs
StatePublished - Oct 1 2014

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Atherosclerosis
Blood Pressure
Hypertension
African Americans
Prehypertension
Cognition
Antihypertensive Agents
Mississippi
Dementia
Outcome Assessment (Health Care)
Guidelines
Therapeutics

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Midlife hypertension and 20-year cognitive change : The atherosclerosis risk in communities neurocognitive study. / Gottesman, Rebecca F; Schneider, Andrea L C; Albert, Marilyn; Alonso, Alvaro; Bandeen Roche, Karen J; Coker, Laura; Coresh, Josef; Knopman, David; Power, Melinda C.; Rawlings, Andreea; Sharrett, A. Richey; Wruck, Lisa M.; Mosley, Thomas H.

In: JAMA Neurology, Vol. 71, No. 10, 01.10.2014, p. 1218-1227.

Research output: Contribution to journalArticle

Gottesman, RF, Schneider, ALC, Albert, M, Alonso, A, Bandeen Roche, KJ, Coker, L, Coresh, J, Knopman, D, Power, MC, Rawlings, A, Sharrett, AR, Wruck, LM & Mosley, TH 2014, 'Midlife hypertension and 20-year cognitive change: The atherosclerosis risk in communities neurocognitive study', JAMA Neurology, vol. 71, no. 10, pp. 1218-1227. https://doi.org/10.1001/jamaneurol.2014.1646
Gottesman, Rebecca F ; Schneider, Andrea L C ; Albert, Marilyn ; Alonso, Alvaro ; Bandeen Roche, Karen J ; Coker, Laura ; Coresh, Josef ; Knopman, David ; Power, Melinda C. ; Rawlings, Andreea ; Sharrett, A. Richey ; Wruck, Lisa M. ; Mosley, Thomas H. / Midlife hypertension and 20-year cognitive change : The atherosclerosis risk in communities neurocognitive study. In: JAMA Neurology. 2014 ; Vol. 71, No. 10. pp. 1218-1227.
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abstract = "IMPORTANCE Hypertension is a treatable potential cause of cognitive decline and dementia, but its greatest influence on cognition may occur in middle age.OBJECTIVE To evaluate the association between midlife (48-67 years of age) hypertension and the 20-year change in cognitive performance.Design, Setting, and Participants The Atherosclerosis Risk in Communities cohort (1990-1992 through 2011-2013) underwent evaluation at field centers inWashington County, Maryland, Forsyth County, North Carolina, Jackson, Mississippi, and the Minneapolis, Minnesota, suburbs. Of 13 476 African American and white participants with baseline cognitive data, 58.0{\%}of living participants completed the 20-year cognitive follow-up.Exposures Hypertension, prehypertension, or normal blood pressure (BP) at visit 2 (1990-1992) constituted the primary exposure. Systolic BP at visit 2 or 5 (2011-2013) and indication for treatment at visit 2 based on the Eighth Joint National Committee (JNC-8) hypertension guidelines constituted the secondary exposures.Main Outcomes and Measures Prespecified outcomes included the 20-year change in scores on the DelayedWord Recall Test, Digit Symbol Substitution Test, andWord Fluency Test and in global cognition.Results During 20 years, baseline hypertension was associated with an additional decline of 0.056 global z score points (95{\%}CI, -0.100 to -0.012) and prehypertension was associated nonsignificantly with 0.040 more global z score points of decline (95{\%}CI, -0.085 to 0.005) compared with normal BP. Individuals with hypertension who used antihypertensives had less decline during the 20 years than untreated individuals with hypertension (-0.050 [95{\%} CI, -0.003 to -0.097] vs -0.079 [95{\%}CI, -0.156 to -0.002] global z score points). Having a JNC-8-specified indication for initiating antihypertensive treatment at baseline was associated with a greater 20-year decline (-0.044 [95{\%}CI, -0.085 to -0.003] global z score points) than not having an indication.We observed effect modification by race for the continuous systolic BP analyses (P = .01), with each 20-mm Hg increment at baseline associated with an additional decline of 0.048 (95{\%}CI, -0.074 to -0.022) points in global cognitive z score in whites but not in African Americans (decline, -0.020 [95{\%}CI, -0.026 to 0.066] points). Systolic BP at the end of follow-up was not associated with the preceding 20 years of cognitive change in either group.Methods to account for bias owing to attrition strengthened the magnitude of some associations.Conclusions and Relevance Midlife hypertension and elevated midlife but not late-life systolic BP was associated with more cognitive decline during the 20 years of the study. Greater decline is found with higher midlife BP in whites than in African Americans.",
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TY - JOUR

T1 - Midlife hypertension and 20-year cognitive change

T2 - The atherosclerosis risk in communities neurocognitive study

AU - Gottesman, Rebecca F

AU - Schneider, Andrea L C

AU - Albert, Marilyn

AU - Alonso, Alvaro

AU - Bandeen Roche, Karen J

AU - Coker, Laura

AU - Coresh, Josef

AU - Knopman, David

AU - Power, Melinda C.

AU - Rawlings, Andreea

AU - Sharrett, A. Richey

AU - Wruck, Lisa M.

AU - Mosley, Thomas H.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - IMPORTANCE Hypertension is a treatable potential cause of cognitive decline and dementia, but its greatest influence on cognition may occur in middle age.OBJECTIVE To evaluate the association between midlife (48-67 years of age) hypertension and the 20-year change in cognitive performance.Design, Setting, and Participants The Atherosclerosis Risk in Communities cohort (1990-1992 through 2011-2013) underwent evaluation at field centers inWashington County, Maryland, Forsyth County, North Carolina, Jackson, Mississippi, and the Minneapolis, Minnesota, suburbs. Of 13 476 African American and white participants with baseline cognitive data, 58.0%of living participants completed the 20-year cognitive follow-up.Exposures Hypertension, prehypertension, or normal blood pressure (BP) at visit 2 (1990-1992) constituted the primary exposure. Systolic BP at visit 2 or 5 (2011-2013) and indication for treatment at visit 2 based on the Eighth Joint National Committee (JNC-8) hypertension guidelines constituted the secondary exposures.Main Outcomes and Measures Prespecified outcomes included the 20-year change in scores on the DelayedWord Recall Test, Digit Symbol Substitution Test, andWord Fluency Test and in global cognition.Results During 20 years, baseline hypertension was associated with an additional decline of 0.056 global z score points (95%CI, -0.100 to -0.012) and prehypertension was associated nonsignificantly with 0.040 more global z score points of decline (95%CI, -0.085 to 0.005) compared with normal BP. Individuals with hypertension who used antihypertensives had less decline during the 20 years than untreated individuals with hypertension (-0.050 [95% CI, -0.003 to -0.097] vs -0.079 [95%CI, -0.156 to -0.002] global z score points). Having a JNC-8-specified indication for initiating antihypertensive treatment at baseline was associated with a greater 20-year decline (-0.044 [95%CI, -0.085 to -0.003] global z score points) than not having an indication.We observed effect modification by race for the continuous systolic BP analyses (P = .01), with each 20-mm Hg increment at baseline associated with an additional decline of 0.048 (95%CI, -0.074 to -0.022) points in global cognitive z score in whites but not in African Americans (decline, -0.020 [95%CI, -0.026 to 0.066] points). Systolic BP at the end of follow-up was not associated with the preceding 20 years of cognitive change in either group.Methods to account for bias owing to attrition strengthened the magnitude of some associations.Conclusions and Relevance Midlife hypertension and elevated midlife but not late-life systolic BP was associated with more cognitive decline during the 20 years of the study. Greater decline is found with higher midlife BP in whites than in African Americans.

AB - IMPORTANCE Hypertension is a treatable potential cause of cognitive decline and dementia, but its greatest influence on cognition may occur in middle age.OBJECTIVE To evaluate the association between midlife (48-67 years of age) hypertension and the 20-year change in cognitive performance.Design, Setting, and Participants The Atherosclerosis Risk in Communities cohort (1990-1992 through 2011-2013) underwent evaluation at field centers inWashington County, Maryland, Forsyth County, North Carolina, Jackson, Mississippi, and the Minneapolis, Minnesota, suburbs. Of 13 476 African American and white participants with baseline cognitive data, 58.0%of living participants completed the 20-year cognitive follow-up.Exposures Hypertension, prehypertension, or normal blood pressure (BP) at visit 2 (1990-1992) constituted the primary exposure. Systolic BP at visit 2 or 5 (2011-2013) and indication for treatment at visit 2 based on the Eighth Joint National Committee (JNC-8) hypertension guidelines constituted the secondary exposures.Main Outcomes and Measures Prespecified outcomes included the 20-year change in scores on the DelayedWord Recall Test, Digit Symbol Substitution Test, andWord Fluency Test and in global cognition.Results During 20 years, baseline hypertension was associated with an additional decline of 0.056 global z score points (95%CI, -0.100 to -0.012) and prehypertension was associated nonsignificantly with 0.040 more global z score points of decline (95%CI, -0.085 to 0.005) compared with normal BP. Individuals with hypertension who used antihypertensives had less decline during the 20 years than untreated individuals with hypertension (-0.050 [95% CI, -0.003 to -0.097] vs -0.079 [95%CI, -0.156 to -0.002] global z score points). Having a JNC-8-specified indication for initiating antihypertensive treatment at baseline was associated with a greater 20-year decline (-0.044 [95%CI, -0.085 to -0.003] global z score points) than not having an indication.We observed effect modification by race for the continuous systolic BP analyses (P = .01), with each 20-mm Hg increment at baseline associated with an additional decline of 0.048 (95%CI, -0.074 to -0.022) points in global cognitive z score in whites but not in African Americans (decline, -0.020 [95%CI, -0.026 to 0.066] points). Systolic BP at the end of follow-up was not associated with the preceding 20 years of cognitive change in either group.Methods to account for bias owing to attrition strengthened the magnitude of some associations.Conclusions and Relevance Midlife hypertension and elevated midlife but not late-life systolic BP was associated with more cognitive decline during the 20 years of the study. Greater decline is found with higher midlife BP in whites than in African Americans.

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