Effect of Hypertension Duration and Blood Pressure Control During Early Adulthood on Cognitive Function in Middle Age

Abstract

Background: Elevated blood pressure (BP) is a risk factor for cognitive impairment. Objective: We aim to explore the association between the duration of hypertension in early adulthood, with cognitive function in midlife. Furthermore, we investigate whether this asssociation is altered among participants with controlled BP. Methods: This prospective study included 2,718 adults aged 18–30 years without hypertension at baseline who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Duration of hypertension was calculated based on repeat measurements of BP performed at 2, 5, 7, 10, 15, 20, and 25 years after baseline. Cognitive function was assessed at Year-25 using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop test. Results: After multivariable adjustment, a longer hypertension duration was associated with worse verbal memory (RAVLT, p trend = 0.002) but not with processing speed (DSST, p trend = 0.112) and executive function (Stroop test, p trend = 0.975). Among subgroups of participants with controlled (BP < 140/90 mmHg) and uncontrolled (SBP≥140 mmHg or DBP≥90 mmHg) BP at the time of cognitive assessment (i.e., Year-25 BP), longer duration of hypertension was associated with worse verbal memory. Similar results were observed in subgroups with controlled and uncontrolled average BP prior to cognitive assessment. Conclusion: Longer duration of hypertension during early adulthood is associated with worse verbal memory in midlife regardless of current or long-term BP control status. The potential risk of hypertension associated cognitive decline should not be overlooked in individuals with a long duration of hypertension, even if BP levels are controlled.

Hypertension and hyperhomocysteinemia as modifiable risk factors for Alzheimer's disease and dementia: New evidence, potential therapeutic strategies, and biomarkers

“…52 Another recent longitudinal study has revealed that longer duration of hypertension during early adulthood corresponded to weakened verbal memory performance during midlife, demonstrating hypertension as a risk factor for cognitive decline. 53 It was also shown that systolic blood pressure is negatively associated with blood flow in the cortex as well as specifically in the hippocampus, with a decrease in cortical and hippocampal perfusion as systolic blood pressure increases. 54 Interestingly, this study found that individuals with hypertension also experience this trend, but there seems to be an optimal mid-range systolic blood pressure that allows perfusion to be maximized and this should be further explored.…”

“…A study conducted in 2021 demonstrated that high resting heart rate (≥80 bpm), which is highly associated with hypertension, corresponded to a higher risk of dementia as well as accelerated progression of cognitive decline in an aging population 52 . Another recent longitudinal study has revealed that longer duration of hypertension during early adulthood corresponded to weakened verbal memory performance during midlife, demonstrating hypertension as a risk factor for cognitive decline 53 . It was also shown that systolic blood pressure is negatively associated with blood flow in the cortex as well as specifically in the hippocampus, with a decrease in cortical and hippocampal perfusion as systolic blood pressure increases 54 .…”

Angiotensin II differentially affects hippocampal glial inflammatory markers in young adult male and female mice

“…There is emerging evidence that hypertension is becoming more common in late adolescence and early adulthood (Azegami et al 2021;Hamrahian and Falkner 2022). In addition, there is increasing awareness that the duration of hypertension can impact the onset of neural degeneration (Schaare et al 2019;Yang et al 2021) and cognitive dysfunction (Yaffe et al 2014(Yaffe et al , 2021Mahinrad et al 2020;Zhou et al 2022). Although the age of onset of hypertension may influence the trajectory of degenerative disease in later life, the effect of hypertension on brain health in young adult subjects is relatively underinvestigated.…”

Hypertension Status Moderated the Relationship between the Hippocampal Subregion of the Left GC-ML-DG and Cognitive Performance in Subjective Cognitive Decline

“…Furthermore, we found that SCD with hypertension had longer visual response times in divided attention. Recent studies have shown that the cognitive domains negatively affected by hypertension include abstract reasoning and/or executive function, memory, and mental processing speed [ 8 , 29 , 30 ]. The above findings of this study are similar to those of previous studies.…”