Association of hypertension in early adulthood and blood pressure change with neuroimaging biomarkers in old age Key points Are hypertension and blood pressure changes in early adulthood associated with brain health in old age? Are there variations according to sex? Findings In this cohort study of 427 adults aged 50 years or older, hypertension and increased blood pressure in early adulthood were associated with lower mean regional brain volumes and poorer white matter integrity in old age. These associations were stronger in men compared to women in some regions. Meaning These findings suggest that prevention and treatment of hypertension in early adulthood has important implications for brain health in later life and may be especially important for men. |
Importance
The association between hypertension developed before midlife and brain health in old age has not been studied and, due to the cardioprotective benefits of estrogen before menopause, may differ by sex.
Aim
To evaluate the association of hypertension in early adulthood and blood pressure (BP) change with neuroimaging biomarkers in old age and examine potential sex differences.
Design, environment and participants
This cohort study used data from the Study of Healthy Aging in African Americans (STAR) and Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) studies, which were harmonized longitudinal cohorts of racially and ethnically diverse adults aged 50 years and older in the area. of the San Francisco Bay and the Sacramento Valley in California. The STAR was conducted from November 6, 2017 to November 5, 2021, and the KHANDLE study was conducted from April 27, 2017 to June 15, 2021.
The current study included 427 participants from the KHANDLE and STAR studies who received health evaluations between June 1, 1964 and March 31, 1985. Regional brain volumes and white matter ( WM) integrity were measured by MRI images between June 1, 2017 and March 1, 2022.
Exhibitions
Hypertension status ( normotension, transition to hypertension, and hypertension ) and BP change (last measurement minus first measurement) were assessed at 2 multiphasic health controls (MHC; 1964-1985) in early adulthood (ages 30-1985). 40 years).
Main results and measures
Regional brain volumes and white matter (WM) integrity were measured using 3T magnetic resonance imaging and z-standardized. General linear models adjusted for potential confounders (demographic and study characteristics [KHANDLE or STAR]) were used to evaluate the association of hypertension and BP changes with neuroimaging biomarkers. Sexual interactions were tested.
Conclusions and relevance
In this cohort study, early adulthood hypertension and BP change were associated with late-life volumetric and white matter (WM) differences implicated in neurodegeneration and dementia .
Sex differences were observed for some brain regions in which hypertension and increased BP appeared more detrimental to men.
These findings suggest that prevention and treatment of hypertension in early adulthood are important for brain health in later life, particularly among men.
Comments
High blood pressure in early adulthood is associated with worse brain health in old age, according to a new study. Men, compared to women, may be more vulnerable to the detrimental effects of high blood pressure on the brain in some brain regions.
The research, published in JAMA Network Open , compared magnetic resonance imaging (MRI) brain scans of older adults who had high blood pressure in their 30s and 40s with older adults who had normal blood pressure.
The researchers found that the high blood pressure group had significantly lower regional brain volumes and worse white matter integrity. Both factors are associated with dementia.
The research also showed that negative brain changes in some regions, such as decreased gray matter volume and frontal cortex volume, were stronger in men. They note that the differences may be related to the protective benefits of estrogen before menopause.
"Treatment for dementia is extremely limited, so identifying modifiable risk and protective factors across the lifespan is key to reducing the burden of the disease," said first author Kristen M. George, professor assistant in the Department of Public Health Sciences.
"High blood pressure is an incredibly common and treatable risk factor associated with dementia. This study indicates that high blood pressure status in early adulthood is important for brain health decades later," George said.
Data from healthy aging studies
Researchers analyzed data from 427 participants in the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the Study of Healthy Aging in African Americans (STAR). This gave them health data from 1964 to 1985 for a diverse cohort of Asian, Black, Latino, and White older adults.
They obtained two blood pressure readings from when the participants were between 30 and 40 years old. This allowed them to determine whether they had been hypertensive, transitioning to hypertensive, or had normal blood pressure in young adulthood.
Participants’ MRIs performed between 2017 and 2022 allowed them to look for late-life neuroimaging biomarkers of neurodegeneration and white matter integrity.
A significant reduction in cerebral gray matter volume is observed in both men and women with hypertension, but it is more intense in men.
Brain Scans Reveal Differences
Compared to participants with normal blood pressure , brain scans of those transitioning to high blood pressure or with high blood pressure showed increased cerebral gray matter volume, frontal cortex volume, and fractional anisotropy (a measure of connectivity). brain) lower. The scores of men with high blood pressure were lower than those of women.
The study joins a growing body of evidence that cardiovascular risk factors in young adulthood are detrimental to brain health in old age.
The researchers note that due to sample size, they were unable to examine racial and ethnic differences and recommended interpreting the results with respect to sex differences with caution. They also note that the MRI data was only available at one time point at the end of life. This can only determine physical properties such as volumetric differences, not specific evidence of neurodegeneration over time.
"This study truly demonstrates the importance of early life risk factors, and that to age well, you need to take care of yourself throughout life: heart health is brain health," said Rachel Whitmer, lead author of the study. . Whitmer is a professor in the departments of Public Health Sciences and Neurology and head of the Division of Epidemiology. She is also associate director of the UC Davis Alzheimer’s Disease Center.
"We are excited to continue following these participants and discover more about what one can do in the first years of life to prepare for healthy brain aging in old age," Whitmer said.
