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

Abstract

Background: Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure.

Aims: To examine lifetime blood pressure as a predictor of brain structure in old age.

Method: A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities.

Results: Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy.

Conclusions: 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.

Conflict of interest statement

Declaration of interest

K.P.E. has received consultation fees from Lilly.

Royal College of Psychiatrists.

Figures

Fig. 1

Age- and gender-adjusted association of hypertension status in 2012–2013 with visual magnetic resonance imaging (MRI) outcomes (*P<0.05).

Fig. 2

Age- and gender-adjusted association between mean arterial pressure over 24 years and automated white matter hyperintensity volume (95% confidence intervals shown with dashed line).