Associations Between Brain Volumes and Cognitive Tests with Hypertensive Burden in UK Biobank

Abstract

Background: Mid-life hypertension is an established risk factor for cognitive impairment and dementia and related to greater brain atrophy and poorer cognitive performance. Previous studies often have small sample sizes from older populations that lack utilizing multiple measures to define hypertension such as blood pressure, self-report information, and medication use; furthermore, the impact of the duration of hypertension is less extensively studied. Objective: To investigate the relationship between hypertension defined using multiple measures and length of hypertension with brain measure and cognition. Methods: Using participants from the UK Biobank MRI visit with blood pressure measurements (n = 31,513), we examined the cross-sectional relationships between hypertension and duration of hypertension with brain volumes and cognitive tests using generalized linear models adjusted for confounding. Results: Compared with normotensives, hypertensive participants had smaller brain volumes, larger white matter hyperintensities (WMH), and poorer performance on cognitive tests. For total brain, total grey, and hippocampal volumes, those with greatest duration of hypertension had the smallest brain volumes and the largest WMH, ventricular cerebrospinal fluid volumes. For other subcortical and white matter microstructural regions, there was no clear relationship. There were no significant associations between duration of hypertension and cognitive tests. Conclusion: Our results show hypertension is associated with poorer brain and cognitive health however, the impact of duration since diagnosis warrants further investigation. This work adds further insights by using multiple measures defining hypertension and analysis on duration of hypertension which is a substantial advance on prior analyses—particularly those in UK Biobank which present otherwise similar analyses on smaller subsets.

Understanding the inter‐relationships of type 2 diabetes and hypertension with brain and cognitive health: A UK Biobank study

“…Important insights from these studies include that diabetes is associated with slower reaction times, 5,7 poorer brain health as indexed by structural and diffusion indices, and an increased risk of vascular, Alzheimer's disease and all‐cause dementia 6,7 . The relationship between hypertension and a range of adverse cognitive and brain health variables is also well established 8‐12 . Hypertension in mid‐life is also known to increase the risk of both Alzheimer's disease and vascular dementia 10,12 …”

“…6,7 The relationship between hypertension and a range of adverse cognitive and brain health variables is also well established. [8][9][10][11][12] Hypertension in mid-life is also known to increase the risk of both Alzheimer's disease and vascular dementia. 10,12 Importantly, global estimates show that more than 50% of adults with diabetes also have a hypertension diagnosis.…”

Understanding the interrelationships of type-2 diabetes and hypertension with brain and cognitive health: a UK Biobank study

“…These participants also provided demographic, health, and socioeconomic information using touchscreen questionnaires as well as taking part in a nurse-led interview asking questions about medical history and medications. Participants who reported they had any neurodegenerative or related diseases were excluded from this analysis (n = 612) as in previous work [9]. A full list of these diseases and UK Biobank field codes for all variables used in this work can be found in Supporting Tables 1 and 2.…”

“…Important insights from these studies include that diabetes is associated with: slower reaction times [5,7], poorer brain health as indexed by structural and diffusion indices and increased risk of vascular, Alzheimer's and all-cause dementia [6,7]. The relationship between hypertension and a range of adverse cognitive and brain health parameters is also well established [8][9][10][11][12]. Hypertension in mid-life is also known to increase the risk of both Alzheimer's and vascular dementia [10,12].…”

Effects of Higher Normal Blood Pressure on Brain Are Detectable before Middle-Age and Differ by Sex

“…Despite the overwhelming evidence linking hypertension to cerebrovascular disease [ 5 , 6 , 7 ], and dementia [ 8 , 9 ] the time at which increasing BP starts impairing brain structure and function has not been determined. High BP in middle age has been found to be associated with the development of neurofibrillary tangles [ 10 ], amyloid angiopathy [ 11 ], as well as brain atrophy [ 5 ].…”