Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

Abstract

Background: A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment.

Methods: In Nord-Trøndelag County, Norway, incident dementia data were collected during 1995-2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects' personal identification numbers, the dementia data were linked to data from the Nord-Trøndelag Health Study (the HUNT Study), a large, population-based health study performed in 1984-1986 (HUNT 1) and 1995-1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2.

Results: Over the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years.

Conclusions: Our data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in individuals over the age of 60 years. We cannot exclude a survival effect, however. Among middle-aged subjects (<60 years), elevated systolic blood pressure and pulse pressure were associated with eventual Alzheimer disease in individuals who reported using antihypertensive medication.

Keywords: Alzheimer disease; Blood pressure; Epidemiology; Prospective case cohort; Risk factors; Vascular dementia.

Fig. 1

Flowchart of the present study describing the selection criteria for the HMS dementia panels (a); HUNT 1 and HUNT 2 (b); and how these two studies were linked (c). HMS Health and Memory Study of Nord-Trøndelag (1995–2010), MCI Mild cognitive impairment, HUNT 1 Helse Undersøkelse Nord-Trøndelag (1984–1986), HUNT 2 Helse Undersøkelse Nord-Trøndelag (1995–1997), Q1 Questionnaire 1, Q2 Questionnaire 2, AD Alzheimer disease, VaD Vascular dementia