Blood pressure and cognitive decline – the impact of hypertension over one decade

ABSTRACT

Background

Midlife hypertension is a risk factor for cognitive decline in late-life but little is known about the impact of long-term hypertension on cognitive change over time.

Methods

We examined blood pressure and cognitive function in 2777 participants (baseline: 2000–2003, 45–75 years, 48.4% men) from the Heinz Nixdorf Recall study. Blood pressure was assessed at three study visits and cognitive function was assessed at both follow-ups (mean follow-up: 5.1 years). Z-score differences in five neuropsychological tests, defining cognitive decline, were derived from linear regression models including age and education. The association of cognitive decline over 5 years and blood pressure over 10 years (classified as: normal blood pressure (>10 years, reference), prevalent hypertension (>10 years), incident hypertension t1 (>5 years), incident hypertension t2 (<5 years), temporary hypertension (at least one hypertensive reading)) was calculated using linear regression models resulting in coefficient b and 95% confidence interval. We calculated interactions with age (linear and with a cutoff at 65 years).

Results

Participants with prevalent hypertension showed a greater cognitive decline in both verbal memory tests. Incident hypertension t1 was associated with a greater decline in the visuospatial organization test. There was no interaction with age.

Conclusion

This study showed that prevalent high blood pressure over 10 years is related to cognitive decline. Prevalent hypertension with longer exposure time may be more detrimental than temporary hypertension for cognitive function.

KEYWORDS:

• Hypertension
• cognitive decline
• epidemiology
• aging

Acknowledgments

Advisory Board

Meinertz T., Hamburg, Germany (Chair); Bode C., Freiburg, Germany; de Feyter P.J., Rotterdam, Netherlands; Güntert B., Hall LT, Austria; Gutzwiller F., Bern, Switzerland; Heinen H., Bonn, Germany; Hess O., Bern, Switzerland; Klein B., Essen, Germany; Löwel H., Neuherberg, Germany; Reiser M., Munich, Germany; Schmidt G. (†), Essen, Germany; Schwaiger M., Munich, Germany; Steinmüller C., Bonn, Germany; Theorell T., Stockholm, Sweden; Willich S.N., Berlin, Germany.

Criteria and Endpoint Committee

Sources of funding

The authors thank the Heinz Nixdorf Foundation [Chairman: Martin Nixdorf; Past Chairman: Dr jur. Gerhard Schmidt (†)], for their generous support of this study. The study was also supported by the German Ministry of Education and Science [BMBF project: 01EG0401, 01GI0856, 01GI0860, 01GS0820_WB2-C, 01ER1001D, 01GI0205], the Deutsche Forschungsgemeinschaft [DFG project: SI 236/8-1, SI 236/9-1, SI 236/10-1, JO 170/8-1, ER155/6-1, KN885/3-1, HO 3314/2-1, HO 3314/2-1, ER155/6-2, HO 3314/2-3, EI 969/2-3, INST 58,219/32-1, PE 2309/2-1], the Ministry of Innovation, Science and Research, North Rhine-Westphalia (MIWF), Deutsche Gesetzliche Unfallversicherung [DGUV project: FF-FP0295] and Else Kröner-Fresenius-Stiftung [project: 2015_A119]. Further, the study was supported by Imatron/GE-Imatron, Merck KG, EU, VW-Stiftung, Celgene GmbH München, Janssen, SarstedtAG&Co., Siemens HealthCare Diagnostics, Roche Diagnostics, Kulturstiftung Essen, Protein Research Unit within Europe (PURE), ResMed Foundation, Competence Network for HIV/AIDS, German Competence Network Heart Failure, IFORES University of Duisburg-Essen and Deanship of the University Hospital of the University of Duisburg-Essen.

Criteria and end point committee

C. Bode, Freiburg, Germany (Chair); K. Berger, Münster, Germany; H.R. Figulla, Jena, Germany; C. Hamm, Bad Nauheim, Germany; P. Hanrath, Aachen, Germany; Kälsch H, Essen, Germany; W. Köpcke, Münster, Germany; B. Ringelstein, Münster, Germany; M. Dichgans, München, C. Weimar, Essen, Germany; A. Zeiher, Frankfurt, Germany.

Statement

The corresponding authors had full access to all data in the study and final responsibility for the submission of the article for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.