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High blood pressure at 50 years linked to dementia after



Action Points

  • Systolic blood pressure ≥130 mm Hg at 50 years, below the conventional threshold of ≥140 mm Hg used to define hypertension, is associated with an increased risk of late dementia, according to with the observational population level research.
  • Note that this association of systolic blood pressure and dementia in adulthood continued even after adjusting for diabetes, coronary heart disease, stroke, atrial fibrillation, heart failure and cardiovascular medication.

Median age that was higher than normal, but below the threshold used to treat hypertension in some countries, was associated with an increased risk of developing dementia later in life, found an analysis of the Whitehall II study long-lasting.

Women who had systolic blood pressure ≥130 mm Hg at age 50 had a 45% higher risk of developing dementia than people with lower systolic blood pressure at the same age, Archana Singh-Manoux reported. , PhD, from the National Institute of Health and Medical Research of France (INSERM) in Paris, and colleagues in European Heart Journal.

This association was not observed at the ages of 60 or 70.

"Our analysis suggests that the importance of middle-aged hypertension in brain health is due to the duration of exposure" said Singh-Manoux in a statement. "Then we see a higher risk for people with high blood pressure at age 50, but not at 60 or 70, because people with hypertension at age 50 are probably more exposed to this risk."

The American Heart Association, the American College of Cardiology and other health organizations recently reduced the threshold for stage 1 hypertension to 130/80 mm Hg for adults, but the NICE guidelines (National Institute of Health and Excellence of Attention) in the United Kingdom and the European Society of Cardiology have thresholds of 140/90 mm Hg.

"This is an important study because it describes the dangers of borderline hypertension, particularly during middle age," said John Bisognano, MD, of the University of Rochester Medical Center in Rochester, New York. , "who did not participate in the study."

"We have known for more than 30 years that people with even mild hypertension have increased cardiovascular risk factors and, presumably, worse outcomes," he said MedPage To day ] "But general public health guidelines have been slow to accept the importance of this condition, as there is a paucity of studies investigating the effect of drug therapy in this group."

Whitehall II is an ongoing study on aging at University College London In this analysis, the researchers evaluated 8,639 people between 35 and 55 years old in 1985 who had their blood pressure measured, and again in 1991, 1997 and 2003. At the end of the study, as of March 2017, 385 people had developed dementia, their average age was 75.2 in the diagnosis of dementia.

The systolic pressure from 130 mm Hg at 50 years, but not at 60 or 70 a was associated with an increased risk of dementia (HR 1.45; 95% CI 1.18 to 1.78). This association continued even after adjusting for diabetes, coronary heart disease, stroke, atrial fibrillation, heart failure and cardiovascular medication (HR 1.38, 95% CI 1.11-1.70). Diastolic blood pressure was not associated with dementia.

Even among people who did not have cardiovascular disease, systolic blood pressure ≥ 130 mm Hg at 50 years was associated with an increased risk of dementia (HR 1.47, 95% CI 1.15 to 1, 87), suggesting that clinical cardiovascular disease did not completely explain the association and that there may be vascular subclinical brain lesions.

"It makes sense that having hypertension for a longer period of time may increase the risk of dementia," Sandra Taler, MD, of the Mayo Clinic in Rochester, Minn., Who was not involved in the study, told ] MedPage Today . "This would certainly create an incentive for middle-aged people to notice their hypertension and reduce blood pressure to normal levels through changes in lifestyle, with or without medications."

"The final message is that blood pressure increases in middle age, it is important to continue and discuss with patients, as things get worse in most people and blood pressure increases as people get older", Bisognano added.

"It is important to point out that when patients are between 30 and 40 years old and the first increase is blood pressure, it is not time to assure them that everything is fine, although they can be sure that they will not begin a journey through the sidewalk moving towards a total hypertension, "he said.

Instead of reassuring them and kicking the can on the way, it's time to focus intensely on their lifestyle and activity level at an age when they can really make a difference and avoid a trajectory that provides them with sustained elevations of their bloo d pressure since they reach 50 and more risk of dementia as they get older. "

This study is observational, the population-level research and the findings do not translate directly into implications for individual patients, the researchers noted. Limitations include the fact that mild diagnoses of dementia may not have been captured in electronic medical records.Due to the small number of patients with dementia, the researchers could not determine whether associations of hypertension were stronger with vascular dementia or Alzheimer's disease.

The Whitehall II study has the support of the N US Health Care UU The Medical Research Council (MRC) and the British Heart Foundation (BHF); Horizon2020; EC Horizon2020; NordForsk and the Academy of Finland.

The researchers reported that there are no conflicts of interest.

2018-06-13T12: 30: 00-0400


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