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Blood pressure from mid- to late life and risk of incident dementia
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OBJECTIVE: To determine the association between blood pressure during midlife (40-64 years) to late life (≥65 years) and risk of incident dementia. METHODS: This study included 1,440 (758 women, mean age 69 ± 6 years) Framingham Offspring participants who were free of dementia and attended 5 consecutive examinations at 4-year intervals starting at midlife (1983-1987, mean age 55 years) until late life (1998-2001, mean 69 years) and subsequently were followed up for incident dementia (mean 8 years). We determined the effect of midlife hypertension (≥140/90 mm Hg), late life hypertension, lower late life blood pressure (<100/70 mm Hg), persistence of hypertension during mid- to late life, and steep decline in blood pressure from mid- to late life over an 18-year exposure period. RESULTS: During the follow-up period, 107 participants (71 women) developed dementia. Using multivariable Cox proportional hazards models, we found that midlife systolic hypertension (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.05-2.35) and persistence of systolic hypertension into late life (HR 1.96, 95% CI 1.25-3.09) were associated with an elevated risk of incident dementia. However, in individuals with low to normal blood pressure (≤140/90 mm Hg) at midlife, a steep decline in systolic blood pressure during mid- to late life was also associated with a >2-fold increase in dementia risk (HR 2.40, 95% CI 1.39-4.15). CONCLUSIONS: Elevated blood pressure during midlife, persistence of elevated blood pressure into late life, and, among nonhypertensives, a steep decline in blood pressure during mid- to late life were associated with an increased dementia risk in a community-based cohort. Our data highlight the potential sustained cognitive benefits of lower blood pressures in midlife but also suggest that declining blood pressure in older adults with prehypertension or normotension, but not in those with hypertension, may be a risk marker for dementia.
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“Life course is important when considering risk, for example, obesity and hypertension in midlife predict future dementia, but both weight and blood pressure usually fall in later life in those with or developing dementia,9 so lower weight and blood pressure in later life might signify illness, not an absence of risk.11, 12, 13, 14”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [12]
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“In the Framingham Offspring cohort comprising 1440 people, elevated systolic blood pressure (≥140 mm Hg in midlife; mean age 55 years) was associated with an increased risk of developing dementia (HR 1·6, 95% CI 1·1–2·4) over an 18 year follow-up period.”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [12]
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“Of note, blood pressure declines in later life and this decline is associated with and, potentially caused by, dementia development (HR 2·4, 95% CI 1·4–4·2).”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [12]
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“In this study risk increased further if hypertension persisted into later life (mean age 69 years; HR 2·0, 95% CI 1·3–3·1).”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [12]
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“Persistent midlife hypertension is associated with increased risk of a late life dementia.”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [12]
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Metadata
- Authors
- McGrath, E. R., Beiser, A. S., DeCarli, C., Plourde, K. L., Vasan, R. S., Greenberg, S. M., & Seshadri, S.
- Affiliations
- Boston University (US)
- From the Department of Neurology (E.R.M.), Brigham & Women's Hospital; Department of Neurology (E.R.M., S.M.G.), Massachusetts General Hospital; Harvard Medical School (E.R.M., S.M.G.); Boston University School of Medicine (A.S.B., R.S.V., S.S.); Boston University School of Public Health (A.S.B., K.L.P., R.S.V.); Framingham Heart Study (A.S.B., R.S.V., S.S.), MA; and 7Department of Neurology (C.D.), University of California, Davis.
- ORCID
- Venue
- Neurology
- Published
- 2017-12-12
- Volume
- 89
- Issue
- 24
- Pages
- 2447-2454
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC5729797
- OpenAlex
- W2767297946
- Cited by
- 289
- References
- 37
- Citations by year
- 2026: 31 · 2025: 40 · 2024: 42 · 2023: 42 · 2022: 44 · 2021: 37 · 2020: 19 · 2019: 22 · 2018: 12
- FWCI
- 11.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (P30AG010129, U01AG049505, U01AG052409, R01AG054076, R01AG049607, R01AG033193)
- National Institute of Neurological Disorders and Stroke (UH2NS100605, R01NS017950)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure, dementia, hypertension, midlife, old age, systolic blood pressure, blood pressure reduction, prehypertension, normotension, dementia risk, Framingham Offspring cohort
- MeSH terms
- Adult, Aged, Blood Pressure, Dementia, Female, Humans, Hypertension, Male, Middle Aged, United States, Cohort Studies, Incidence, Multivariate Analysis, Proportional Hazards Models, Prehypertension
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