Long-term blood pressure patterns in midlife and dementia in later life: Findings from the Framingham Heart Study

Abstract

Introduction: Long-term blood pressure (BP) measures, such as visit-to-visit BP variability (BPV) and cumulative BP, are strong indicators of cardiovascular risks. This study modeled up to 20 years of BP patterns representative of midlife by using BPV and cumulative BP, then examined their associations with development of dementia in later life.

Methods: For 3201 individuals from the Framingham Heart Study, multivariate logistic regression analyses were performed to examine the association between long-term BP patterns during midlife and the development of dementia (ages ≥ 65).

Results: After adjusting for covariates, every quartile increase in midlife cumulative BP was associated with a sequential increase in the risk of developing dementia (e.g., highest quartile of cumulative systolic blood pressure had approximately 2.5-fold increased risk of all-cause dementia). BPV was not significantly associated with dementia.

Discussion: Findings suggest that cumulative BP over the course of midlife predicts risk of dementia in later life. HIGHLIGHTS Long-term blood pressure (BP) patterns are strong indicators of vascular risks. Cumulative BP and BP variability (BPV) were used to reflect BP patterns across midlife. High cumulative BP in midlife is associated with increased dementia risk. Visit-to-visit BPV was not associated with the onset of dementia.

Keywords: blood pressure; dementia; midlife; prevention.

Figure 1.. Figural Representation of Long-Term Blood Pressure Modeling

Blood pressure (BP) modeling is based on the observation phase if participants attended all 5 examinations. For the Original Cohort, the observation phase began at the fourth examination, and for the Offspring Cohort, it began at the first examination. The hinge examination was the last examination within the observation phase. The follow-up phase began at the hinge examination and was used to determine the presence of dementia late life.

Figure 2.. Flowchart of the study sample

The process of participant selection and exclusions are presented.

Figure 3.. Association Between Dementia and Cumulative SBP (Figure 3A) and DBP (Figure 3B) groups

The x-axis represents different quartiles of cumulative systolic blood pressure (CSBP)(Figure 3A) and cumulative diastolic blood pressure (CDBP)(Figure 3B). The y-axis represents odds ratio of developing all-cause dementia (front row) and Alzheimer’s disease (back row).