Lifetime hypertension as a predictor of brain structure in older adults: cohort study with a 28-year follow-up

Allan, Charlotte L.; Zsoldos, Enikő; Filippini, Nicola; Sexton, Claire E.; Topiwala, Anya; Valkanova, Vyara; Singh‐Manoux, Archana; Tabák, Ádám G.; Shipley, Martin J.; Mackay, Clare E.; Ebmeier, Klaus P.; Kivimäki, Mika

doi:10.1192/bjp.bp.114.153536

Cited by 41 publications

(30 citation statements)

References 43 publications

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“…Hypertension is the most important risk factor for the development of WMH. 99,180–182 Hypertension in general, 180,183–185 high SBP, 99,185–190 high DBP, 186,189,191–193 low DBP, 194 pulse pressure, 185 mean arterial pressure, 195,196 pulse wave velocity, 197 and arterial stiffness 198 have all been associated with WMHs, and it is not clear that one measure of BP predominates over the others in magnitude of the association. Treatment adds considerable complexity to the relationship between hypertension and WMH, but a few clinical trials have shown that WMH progression is reduced with antihypertensive treatment.…”

Section: Hypertension and Admentioning

confidence: 99%

Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

Iadecola¹,

Yaffe²,

Biller³

et al. 2016

Hypertension

561

474

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Background Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. Methods Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. Results Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. Conclusions After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.

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Section: Hypertension and Admentioning

confidence: 99%

Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

Iadecola¹,

Yaffe²,

Biller³

et al. 2016

Hypertension

561

474

View full text Add to dashboard Cite

show abstract

“…51,52 WMHs are likely more common in individuals with stroke, dementia, migraine, 53,54 or late-life depression 55 but not in younger adults with bipolar disease or schizophrenia. 56 In community-based samples, WMH prevalence was low before 55 years of age 57 but increased sharply with age thereafter, from 11% to 21% in the subjects 64 years of age on average to 94% in individuals 82 years of age on average.…”

Section: White Matter Hyperintensitymentioning

confidence: 99%

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith¹,

Saposnik²,

Biessels³

et al. 2017

Stroke

304

297

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Abstract-Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. (Stroke. 2017;48:e44-e71.

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“…We defined hypertension as elevated BP in a clinical session, physician diagnosis, and/or the use of antihypertensive medication. Such a definition may lead to some misclassification, but this method has been used extensively in the Whitehall II where it produces valid results [41, 42], and similar criteria are employed in other epidemiological studies such as the Atherosclerosis Risk in Communities and Framingham Heart Studies [43, 44]. We did not obtain measures of dietary sodium and potassium that are potentially relevant.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure and Fibrinogen Responses to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period

et al. 2016

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BackgroundHeightened blood pressure (BP) responses to mental stress predict raised BP levels over subsequent years, but evidence for associations with incident hypertension is limited, and the significance of inflammatory responses is uncertain.PurposeWe investigated the relationship between BP and plasma fibrinogen responses to stress and incident hypertension over an average 8-year follow-up.MethodParticipants were 636 men and women (mean age 59.1 years) from the Whitehall II epidemiological cohort with no history of cardiovascular disease and hypertension. They performed standardized behavioral tasks (color/word conflict and mirror tracing), and hypertension was defined by clinic measures and medication status.ResultsOf participants in the highest systolic BP reactivity tertile, 29.3 % became hypertensive over the follow-up period compared with 16.5 % of those in the lowest tertile, with an odds ratio of 2.02 (95 % CI 1.17–3.88, p = 0.012) after adjustment for age, sex, grade of employment, body mass index, smoking, alcohol consumption, physical activity, follow-up time, subjective stress response, perceived task difficulty, perceived task engagement, and baseline BP. Similar associations were observed for diastolic BP reactivity (odds ratio 2.05, 95 % CI 1.23–3.40, p = 0.006) and for impaired systolic BP post-stress recovery (odds ratio 2.06, 95 % CI 1.19–3.57, p = 0.010). Fibrinogen reactions to tasks also predicted future hypertension in women (odds ratio 2.64, 95 % CI 1.11–6.30, p = 0.029) but not men.ConclusionsThese data suggest that heightened cardiovascular and inflammatory reactivity to mental stress is associated with hypertension risk, and may be a mechanism through which psychosocial factors impact on the development of hypertension.

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Lifetime hypertension as a predictor of brain structure in older adults: cohort study with a 28-year follow-up

Abstract: Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose-response pattern.

Cited by 41 publications

References 43 publications

Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Blood Pressure and Fibrinogen Responses to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period

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