Hypertension Linked to Cognitive Decline at All Ages

Laurie Barclay, MD

October 04, 2004

Oct. 4, 2004 -- High blood pressure is likely to cause cognitive decline in young people as well as old, according to the results of a longitudinal study published in the Oct. 4 Online First issue of Hypertension.

"Systolic and diastolic blood pressures have been inversely related to cognitive performance in prospective and cross-sectional studies," write Penelope K. Elias, PhD, from the University of Maine in Orono, and colleagues. "However, in large, community-based samples, these findings have been limited to older adults."

The investigators followed 529 participants in the Maine-Syracuse Longitudinal Study of Hypertension for 20 years. Using a two-step growth curve method, they modeled the relation between various indices of cognitive performance on the Wechsler Adult Intelligence Scale and the baseline blood pressure in two age groups, 18 to 46 years and 47 to 83 years, while accounting for covariates.

In young as well as in older subjects, systolic, diastolic, and mean arterial blood pressures at enrollment and the blood pressure categories as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure predicted the decline in Visualization/Fluid abilities, but not Crystallized/Verbal, Memory, and Speed performance.

Study limitations include relatively well-educated subjects and greater loss to follow-up of subjects with lower cognitive scores.

"Young adults are as susceptible to longitudinal blood pressure-related decline in cognitive performance as are older adults," the authors write. "To the extent that blood pressure effects on cognition are not reversible, it is important to prevent an increase in blood pressure levels as early as possible in the life cycle."

The National Institute on Aging and the National Heart, Lung, and Blood Institute supported this study.

In an accompanying editorial, Jan A. Staessen, from the University of Leuven in Belgium, and Willem H. Birkenhager, from Erasmus University in Rotterdam, the Netherlands, review previous studies linking hypertension to dementia and conclude that this study "breaks new ground."

"Because of the worldwide demographic transition from high to low rates of birth and death, dementia is growing fast into one of the principal causes of major disability and mortality," Drs. Staessen and Birkenhager write.

"In view of the human suffering, clinical trials must be mounted to specifically address the question of whether blood pressure-lowering with or without calcium channel blockade can prevent Alzheimer disease," Drs. Staessen and Birkenhager conclude. "Public research bodies, regulators, and the pharmaceutical industry should no longer remain indifferent, but take up the gauntlet. Quo usque tandem abutere patientia nostra?"

The editors note that the opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.

Hypertension. Published online Oct. 4, 2004.

Reviewed by Gary D. Vogin, MD


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