Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May;83(5):935-944.
doi: 10.1002/ana.25228. Epub 2018 May 11.

Blood pressure and risk of incident Alzheimer's disease dementia by antihypertensive medications and APOE ε4 allele

Kumar B Rajan  1   2 , Lisa L Barnes  2 , Robert S Wilson  3 , Jennifer Weuve  4 , Elizabeth A McAninch  5 , Denis A Evans  5
Affiliations

Blood pressure and risk of incident Alzheimer's disease dementia by antihypertensive medications and APOE ε4 allele

Kumar B Rajan et al. Ann Neurol. 2018 May.

Abstract

Objective: To examine the association of blood pressure (BP) with incident Alzheimer's disease (AD) dementia.

Methods: This work is based on a longitudinal, cohort study of 18 years, the Chicago Health and Aging Project (CHAP) performed in 2,137 participants (55% black) with systolic BP measured around 8.1 years before incident AD dementia.

Results: The association of BP with risk of AD dementia was U-shaped, with the lowest risks of AD dementia near the center of the systolic BP (SBP) and diastolic BP (DBP) distributions, and modestly elevated risk at lower BPs, and greater risk at higher BPs. The degree of U-shape and the range of lowest risk (threshold ranges) varied with antihypertensive medication use and presence of the APOE ε4 allele. The U-shape was most prominent for the subgroup not taking antihypertensive medications and having an APOE ε4 allele. At higher BPs, those having the APOE ε4 allele and not receiving antihypertensive medication were at greater risk of AD dementia than other groups: The risk of incident AD dementia increased by 100% (relative risk [RR] = 2.00; 95% confidence interval [CI] = 1.70, 2.31) for every 10 mm Hg increase in SBP above 140 mm Hg. For DBP, the risk of incident of AD dementia increased by 57% (RR = 1.57; 95% CI = 1.33, 1.86) for every 5 mm Hg increase in DBP above 76 mm Hg.

Interpretation: The BP risk of AD dementia association is U-shaped, with elevated risk at lower and higher BPs. People having the APOE ε4 allele and not receiving antihypertensive medication with higher BPs have notably elevated risk of AD dementia. Ann Neurol 2018;83:935-944.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of Interest: Nothing to report.

Figures

Figure 1
Figure 1
Selection of Clinical Evaluation for Incident AD Dementia and DNA Extraction from the Population Sample Note: End-of-study: Successive age cohorts who had less follow-up than the original cohort
Figure 2
Figure 2
Log Hazard Function for the Associations of Systolic and Diastolic BP with Clinical Diagnosis of Incident AD dementia
Figure 3
Figure 3
Log Hazard Function for the Association of Systolic and Diastolic BP with the Clinical Diagnosis of Incident AD dementia by BP Medication Use and the APOE ε4 Allele
Figure 4
Figure 4
Log Hazard Function for the Association of Systolic BP with Clinical Diagnosis of Incident AD dementia in Combinations of BP Medication Use and the APOE ε4 Allele
See this image and copyright information in PMC

References

    1. Purnell C, Gao S, Callahan CM, Hendrie HC. Cardiovascular risk factors and incident Alzheimer disease: a systematic review of the literature. Alzheimer Dis Assoc Disord. 2009;23:1–10. - PMC - PubMed
    1. Power MC, Weuve J, Gagne JJ, et al. The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis. Epidemiology. 2011;22:646–659. - PMC - PubMed
    1. Kivipelto M, Helkala EL, Laakso MP, et al. Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Ann Intern Med. 2002;137:149–155. - PubMed
    1. Bermejo-Pareja F, Benito-León J, Louis ED, et al. Risk of incident dementia in drug-untreated arterial hypertension: a population-based study. J Alzheimers Dis. 2010;22:949–958. - PubMed
    1. Hayden KM, Zandi PP, Lyketsos CG, et al. Vascular risk factors for incident Alzheimer disease and vascular: The Cache County study. Alzheimer Dis Assoc Disord. 2006;20:93–100. - PubMed

Publication types