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- Title
Year-by-Year Blood Pressure Variability From Midlife to Death and Lifetime Dementia Risk.
- Authors
den Brok, Melina G. H. E.; van Dalen, Jan Willem; Marcum, Zachary A.; Busschers, Wim B.; van Middelaar, Tessa; Hilkens, Nina; Klijn, Catharina J. M.; Moll van Charante, Eric P.; van Gool, Willem A.; Crane, Paul K.; Larson, Eric B.; Richard, Edo
- Abstract
This cohort study examines the association of systolic blood pressure (BP) variability with dementia risk from age 50 years to death in participants in the Adult Changes in Thought study. Key Points: Question: Is systolic blood pressure variability (BPV) at different ages during life differentially associated with lifetime dementia risk? Findings: In this cohort study of 820 participants in the Adult Changes in Thought longitudinal study, year-by-year BPV calculated over the preceding 10 years was associated with a 35% higher dementia risk only in individuals aged 90 years but not in younger persons. Meaning: Findings of this study suggest that high BPV can indicate increased incident dementia risk in older age but is less viable as a potential midlife dementia prevention target. Importance: High visit-to-visit blood pressure variability (BPV) in late life may reflect increased dementia risk better than mean systolic blood pressure (SBP). Evidence from midlife to late life could be crucial to understanding this association. Objective: To determine whether visit-to-visit BPV at different ages was differentially associated with lifetime incident dementia risk in community-dwelling individuals. Design, Setting, and Participants: This cohort study analyzed data from the Adult Changes in Thought (ACT) study, an ongoing population-based prospective cohort study in the US. Participants were 65 years or older at enrollment, community-dwelling, and without dementia. The study focused on a subset of deceased participants with brain autopsy data and whose midlife to late-life blood pressure data were obtained from Kaiser Permanente Washington medical archives and collected as part of the postmortem brain donation program. In the ACT study, participants underwent biennial medical assessments, including cognitive screening. Data were collected from 1994 (ACT study enrollment) through November 2019 (data set freeze). Data analysis was performed between March 2020 and September 2023. Exposures: Visit-by-visit BPV at ages 60, 70, 80, and 90 years, calculated using the coefficient of variation of year-by-year SBP measurements over the preceding 10 years. Main Outcomes and Measures: All-cause dementia, which was adjudicated by a multidisciplinary outcome adjudication committee. Results: A total of 820 participants (mean [SD] age at enrollment, 77.0 [6.7] years) were analyzed and included 476 females (58.0%). A mean (SD) of 28.4 (8.4) yearly SBP measurements were available over 31.5 (9.0) years. The mean (SD) follow-up time was 32.2 (9.1) years in 27 885 person-years from midlife to death. Of the participants, 372 (45.4%) developed dementia. The number of participants who were alive without dementia and had available data for analysis ranged from 280 of those aged 90 years to 702 of those aged 70 years. Higher BPV was not associated with higher lifetime dementia risk at age 60, 70, or 80 years. At age 90 years, BPV was associated with 35% higher dementia risk (hazard ratio [HR], 1.35; 95% CI, 1.02-1.79). Meta-regression of HRs calculated separately for each age (60-90 years) indicated that associations of high BPV with higher dementia risk were present only at older ages, whereas the association of SBP with dementia gradually shifted direction linearly from being incrementally to inversely associated with older ages. Conclusions and Relevance: In this cohort study, high BPV indicated increased lifetime dementia risk in late life but not in midlife. This result suggests that high BPV may indicate increased dementia risk in older age but might be less viable as a midlife dementia prevention target.
- Subjects
WASHINGTON (State); DEMENTIA risk factors; HYPERTENSION; CONFIDENCE intervals; SYSTOLIC blood pressure; AGE distribution; RISK assessment; NEUROPSYCHOLOGICAL tests; INDEPENDENT living; RESEARCH funding; DESCRIPTIVE statistics; BLOOD pressure measurement; STATISTICAL sampling; DATA analysis software; SECONDARY analysis; PROPORTIONAL hazards models; LONGITUDINAL method; DISEASE complications; MIDDLE age; OLD age
- Publication
JAMA Network Open, 2023, Vol 6, Issue 10, pe2340249
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.40249