. 2020 Jul 1;77(7):810-819.

doi: 10.1001/jamaneurol.2020.0568.

Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals

Deborah A Levine^{1

2

3}, Alden L Gross⁴, Emily M Briceño⁵, Nicholas Tilton¹, Mohammed U Kabeto¹, Stephanie M Hingtgen¹, Bruno J Giordani⁶, Jeremy B Sussman^{1

3

7}, Rodney A Hayward^{1

3

7}, James F Burke^{2

3

7}, Mitchell S V Elkind^{8

9}, Jennifer J Manly^{8

10}, Andrew E Moran¹¹, Erin R Kulick¹², Rebecca F Gottesman¹³, Keenan A Walker¹³, Yuichiro Yano¹⁴, Darrell J Gaskin¹⁵, Stephen Sidney¹⁶, Kristine Yaffe^{17

18

19}, Ralph L Sacco²⁰, Clinton B Wright²¹, Veronique L Roger²², Norrina Bai Allen²³, Andrzej T Galecki^{1

24}

Affiliations

¹ Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor.
² Stroke Program, Department of Neurology, University of Michigan, Ann Arbor.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
⁴ Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, John Hopkins University, Baltimore, Maryland.
⁵ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.
⁶ Michigan Alzheimer's Disease Center, Department of Psychiatry, University of Michigan, Ann Arbor.
⁷ VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
⁸ Department of Neurology, Vagelos College of Physicians and Surgeons, New York, New York.
⁹ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
¹⁰ Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York.
¹¹ Division of General Medicine, Department of Medicine, Columbia University, New York, New York.
¹² Department of Epidemiology, Brown University, Providence, Rhode Island.
¹³ Department of Neurology, Johns Hopkins University, Baltimore, Maryland.
¹⁴ Department of Community & Family Medicine, Duke University, Durham, North Carolina.
¹⁵ Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland.
¹⁶ Kaiser Permanente Northern California Division of Research, Oakland.
¹⁷ Department of Psychiatry, University of California, San Francisco, San Francisco.
¹⁸ Department of Neurology, University of California, San Francisco, San Francisco.
¹⁹ Department of Epidemiology, University of California, San Francisco, San Francisco.
²⁰ Department of Neurology, University of Miami, Miami, Florida.
²¹ Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
²² Department of Cardiology and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
²³ Department of Internal Medicine, Northwestern University, Chicago, Illinois.
²⁴ Department of Biostatistics, University of Michigan, Ann Arbor.

PMID: 32282019
PMCID: PMC7154952
DOI: 10.1001/jamaneurol.2020.0568

Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals

Deborah A Levine et al. JAMA Neurol. 2020.

. 2020 Jul 1;77(7):810-819.

doi: 10.1001/jamaneurol.2020.0568.

Authors

Affiliations

¹ Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor.
² Stroke Program, Department of Neurology, University of Michigan, Ann Arbor.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
⁴ Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, John Hopkins University, Baltimore, Maryland.
⁵ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.
⁶ Michigan Alzheimer's Disease Center, Department of Psychiatry, University of Michigan, Ann Arbor.
⁷ VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
⁸ Department of Neurology, Vagelos College of Physicians and Surgeons, New York, New York.
⁹ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
¹⁰ Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York.
¹¹ Division of General Medicine, Department of Medicine, Columbia University, New York, New York.
¹² Department of Epidemiology, Brown University, Providence, Rhode Island.
¹³ Department of Neurology, Johns Hopkins University, Baltimore, Maryland.
¹⁴ Department of Community & Family Medicine, Duke University, Durham, North Carolina.
¹⁵ Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland.
¹⁶ Kaiser Permanente Northern California Division of Research, Oakland.
¹⁷ Department of Psychiatry, University of California, San Francisco, San Francisco.
¹⁸ Department of Neurology, University of California, San Francisco, San Francisco.
¹⁹ Department of Epidemiology, University of California, San Francisco, San Francisco.
²⁰ Department of Neurology, University of Miami, Miami, Florida.
²¹ Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
²² Department of Cardiology and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
²³ Department of Internal Medicine, Northwestern University, Chicago, Illinois.
²⁴ Department of Biostatistics, University of Michigan, Ann Arbor.

PMID: 32282019
PMCID: PMC7154952
DOI: 10.1001/jamaneurol.2020.0568

Erratum in

Error in Methods Section.
[No authors listed] [No authors listed] JAMA Neurol. 2023 Apr 1;80(4):422. doi: 10.1001/jamaneurol.2023.0254. JAMA Neurol. 2023. PMID: 36877509 Free PMC article. No abstract available.

Abstract

Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain.

Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline.

Design, setting, and participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018.

Main outcomes and measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function.

Exposures: Race (black vs white).

Results: Among 34 349 participants, 19 378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19 378 individuals, 10 724 (55.3%) were female and 15 526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P = .004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P < .001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P < .001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P < .001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P < .001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P < .001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P = .56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P < .001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P < .001).

Conclusions and relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Levine reports grants from the National Institutes of Health (NIH) during the conduct of the study and outside the submitted work. Drs Tilton and Hingtgen report grants from the NIH/National Institute of Neurological Disorders and Stroke (NINDS) during the conduct of the study. Dr Sussman reports grants from US Department of Veterans Affairs during the conduct of the study. Dr Hayward reports grants from the NIH and US Department of Veterans Affairs during the conduct of the study. Dr Manly reports grants from NIH/National Institute on Aging during the conduct of the study. Dr Gottesman reports other support from the American Academy of Neurology outside the submitted work. Drs Gaskin and Galecki report grants from the NIH during the conduct of the study. Dr Sidney reports a contract from the National Heart, Lung, and Blood Institute outside the submitted work. Dr Yaffe reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr Sacco reports grants from NINDS during the conduct of the study and grants from Boehringer Ingelheim, American Heart Association, and Florida Department of Health outside the submitted work. Dr Wright reports grants from NIH/NINDS during the conduct of the study and royalties from UpToDate for 2 chapters on vascular dementia. No other disclosures were reported.

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References

1. Alzheimer’s Association 2019 Alzheimer’s disease facts and figures. Alzheimers Dement. 2019;15(3):321-387. doi:10.1016/j.jalz.2019.01.010 - DOI - PubMed
1. Alzheimer’s Disease-Related Dementias Conference and recommendations report to the NINDS council. Published September 12, 2013. Accessed July 1, 2019. https://www.ninds.nih.gov/sites/default/files/ADRD_2013_Report-and-Memor...
1. Gurland BJ, Wilder DE, Lantigua R, et al. . Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry. 1999;14(6):481-493. doi:10.1002/(SICI)1099-1166(199906)14:6<481::AID-GPS959>3.0.CO;2-5 - DOI - PubMed
1. Kuller LH, Lopez OL, Jagust WJ, et al. . Determinants of vascular dementia in the Cardiovascular Health Cognition Study. Neurology. 2005;64(9):1548-1552. doi:10.1212/01.WNL.0000160115.55756.DE - DOI - PMC - PubMed
1. Plassman BL, Langa KM, Fisher GG, et al. . Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427-434. doi:10.7326/0003-4819-148-6-200803180-00005 - DOI - PMC - PubMed

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Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals

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Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals

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