Age at Diagnosis of Hypertension and Cognitive Decline

Age at diagnosis, but not duration, of hypertension was found to be associated with cognitive decline, according to a study published in Hypertension.

Civil servants (N=7063; mean age, 59.9±5.9 years; 55.2% women; 15.3% Black; 22.0% with prehypertension; 46.8% with hypertension) were recruited in 6 Brazilian cities between 2008 and 2010. They attended a primary visit and a secondary visit between 2012 and 2014 during which they underwent cognitive evaluations and blood pressure measurements.

Among participants with hypertension, 29.8% were diagnosed during middle age (median time since diagnosis, 7.0 years; interquartile range [IQR], 1-15 years), and 31.2% had uncontrolled blood pressure.

Participants with vs without hypertension had lower scores on memory tests (b, 0.9158; 95% CI, 0.4990-1.3325; P <.001) and lower global cognitive scores (b, 0.3823; 95% CI, 0.1174-0.6472; P <.01). Participants with vs without prehypertension had lower verbal fluency test scores (b, 0.5596; 95% CI, 0.0948-1.0234; P <.01).

In a model which incorporated age, participants with vs without hypertension had lower scores on: memory tests (b, -0.0153; 95% CI, -0.0222 to -0.0083; P <.001), verbal fluency tests (b, -0.0065; 95% CI, -0.0129 to -0.0001; P <.05), and lower global cognitive scores (b, -0.0072; 95% CI, -0.0115 to -0.0028; P <.01). Participants with vs without prehypertension had lower verbal fluency test scores (b, -0.0095; 95% CI, -0.0172 to -0.0018; P <.01) and lower global cognitive test scores (b, -0.0049; 95% CI, -0.0102 to -0.0003; P <.05).

Using a model that accounted for age, participants with vs without hypertension during middle age performed poorer on memory tests (b, -0.0072; 95% CI, -0.0141 to -0.0003; P <.05), and those diagnosed with hypertension after 55 years performed had lower memory test (b, -0.0151; 95% CI, -0.0237 to -0.0064; P <.001) and global cognitive (b, -0.0080; 95% CI, -0.0134 to -0.0025; P <.01) scores.

Individuals with vs without uncontrolled blood pressure had lower memory test (b, -0.0126; 95% CI, -0.0222 to -0.0030; P <.01) and global cognitive test (b, -0.0074; 95% CI, -0.0134 to -0.0013; P <.01) scores.

Duration of hypertension diagnosis was not found to be associated with memory (P =.109), fluency (P =.885), concentration (P =.266), or global cognitive (P =.457) scores.

This study was limited by the reliance on self-reported age at diagnosis, which may have brought recall bias.

The study authors concluded the age-related decline associated with cognitive impairment among individuals with hypertension may not be factual, as they observed the decline of cognitive function among individuals diagnosed earlier and later in life was similar. Blood pressure control may be key for maintaining cognitive function, as those with uncontrolled blood pressure performed poorer on cognitive tests.

Reference

De Menezes S T, Giatti L, Brant L C C, et al. Hypertension, prehypertension, and hypertension control: Association with decline in cognitive performance in the ELSA-Brasil cohort. Hypertension. 2020;HYPERTENSIONAHA12016080. doi:10.1161/HYPERTENSIONAHA.120.16080