A new observational study suggests that hypertension in middle age could contribute to cognitive decline in the next 20 years. Rebecca F. Gottesman, MD, PhD, of Johns Hopkins, and colleagues found that high blood pressure between the ages of 48 and 67 was associated with 0.056 z score-points of a decline in cognition over 20 years, compared to having normal blood pressure. That is a 6.5% more decline than expected from aging alone.
“Although we note a relatively modest additional decline associated with hypertension,” the researchers wrote, “lower cognitive performance increases the risk for future dementia, and a shift in the distribution of cognitive scores, even to this degree, is enough to increase the public health burden of hypertension and prehypertension significantly.”
The study of 13,476 participants involved close monitoring of blood pressure, standardized cognitive assessment performance, and covariates. Researchers found that individuals being treated for hypertension had a significantly smaller decline of 0.050 global z score points compared to those not being treated for hypertension. These participants saw a decline of 0.079 in a 20 year follow-up period.
“Although other studies have suggested that lower blood pressure might lead to hypoperfusion and thus worse cognitive outcomes in older persons … we found a nearly continuous effect of midlife systolic blood pressure, with steeper cognitive decline as blood pressure increased in whites only,” Gottesman’s group noted.