Bottom Line: Patterns of high blood pressure in midlife that extend to late life or high blood pressure in midlife followed by low blood pressure later in life was associated with increased risk for dementia compared to having normal blood pressure. This observational study included nearly 4,800 participants who had blood pressure measurements taken over 24 years at five visits plus a detailed neurocognitive evaluation during the fifth and a sixth visit, where dementia was assessed. There were 516 new cases of dementia diagnosed between the fifth and sixth visits. Study authors report that compared with maintaining normal blood pressure, an increased risk of dementia was associated with hypertension (greater than 140/90 mm Hg or use of antihypertensive medication) in midlife (age 54 to 63) that was sustained to late life and a pattern of hypertension in midlife and low blood pressure (less than 90/60 mm Hg) later life. Midlife hypertension followed by late-life low blood pressure also was associated with increased risk of mild cognitive impairment. Limitations of the study include that the findings may have been biased because of the increased likelihood that participants with higher blood pressure and poorer cognition during midlife dropped out of the study. Also, study participants were from Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis, so the results may not be generalizable to other areas.
Authors: Keenan A. Walker, Ph.D., Johns Hopkins University School of Medicine, Baltimore, and coauthors
(doi:10.1001/jama.2019.10575)
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