Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans

Deborah A. Levine, Andrzej T. Galecki, Kenneth M. Langa, Frederick Unverzagt, Mohammed U. Kabeto, Bruno Giordani, Mary Cushman, Leslie A. McClure, Monika M. Safford, Virginia G. Wadley

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Although the association between high blood pressure (BP), particularly in midlife, and late-life dementia is known, less is known about variations by race and sex. In a prospective national study of 22 164 blacks and whites ≥45 years without baseline cognitive impairment or stroke from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke), enrolled 2003 to 2007 and followed through September 2015, we measured changes in cognition associated with baseline systolic and diastolic BP (SBP and DBP), as well as pulse pressure (PP) and mean arterial pressure, and we tested whether age, race, and sex modified the effects. Outcomes were global cognition (Six-Item Screener; primary outcome), new learning (Word List Learning), verbal memory (Word List Delayed Recall), and executive function (Animal Fluency Test). Median follow-up was 8.1 years. Significantly faster declines in global cognition were associated with higher SBP, lower DBP, and higher PP with increasing age ( P<0.001 for age×SBP×follow-up-time, age×DBP×follow-up-time, and age×PP×follow-up-time interaction). Declines in global cognition were not associated with mean arterial pressure after adjusting for PP. Blacks, compared with whites, had faster declines in global cognition associated with SBP ( P=0.02) and mean arterial pressure ( P=0.04). Men, compared with women, had faster declines in new learning associated with SBP ( P=0.04). BP was not associated with decline of verbal memory and executive function, after controlling for the effect of age on cognitive trajectories. Significantly faster declines in global cognition over 8 years were associated with higher SBP, lower DBP, and higher PP with increasing age. SBP-related cognitive declines were greater in blacks and men.

Original languageEnglish (US)
Pages (from-to)310-318
Number of pages9
JournalHypertension (Dallas, Tex. : 1979)
Volume73
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Cognition
Blood Pressure
Arterial Pressure
Executive Function
Stroke
Learning
Verbal Learning
Cognitive Dysfunction
hydroquinone
Dementia
Cohort Studies
Prospective Studies
Hypertension

Keywords

  • blood pressure
  • cognition
  • dementia
  • hypertension
  • stroke

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans. / Levine, Deborah A.; Galecki, Andrzej T.; Langa, Kenneth M.; Unverzagt, Frederick; Kabeto, Mohammed U.; Giordani, Bruno; Cushman, Mary; McClure, Leslie A.; Safford, Monika M.; Wadley, Virginia G.

In: Hypertension (Dallas, Tex. : 1979), Vol. 73, No. 2, 01.02.2019, p. 310-318.

Research output: Contribution to journalArticle

Levine, DA, Galecki, AT, Langa, KM, Unverzagt, F, Kabeto, MU, Giordani, B, Cushman, M, McClure, LA, Safford, MM & Wadley, VG 2019, 'Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans', Hypertension (Dallas, Tex. : 1979), vol. 73, no. 2, pp. 310-318. https://doi.org/10.1161/HYPERTENSIONAHA.118.12062
Levine, Deborah A. ; Galecki, Andrzej T. ; Langa, Kenneth M. ; Unverzagt, Frederick ; Kabeto, Mohammed U. ; Giordani, Bruno ; Cushman, Mary ; McClure, Leslie A. ; Safford, Monika M. ; Wadley, Virginia G. / Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans. In: Hypertension (Dallas, Tex. : 1979). 2019 ; Vol. 73, No. 2. pp. 310-318.
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