Associations of hypertension burden on subsequent dementia: a population-based cohort study

Hyunjean Jung,Gregory Y H Lip,Moon-Hyoung Lee,Pil-Sung Yang,Tae-Hoon Kim,Eunsun Jang,Boyoung Joung,Hui-Nam Pak,Hee Tae Yu,Daehoon Kim,Jung-Hoon Sung

doi:10.1038/s41598-021-91923-8

Abstract

In this nationwide cohort study, we assessed the effects of hypertension burden and blood pressure (BP) control on dementia in different age subgroups. From the Korean National Health Insurance Service-Health Screening cohort from January 1, 2005 to December 31, 2013, we enrolled 428,976 subjects aged 40–79 years without previous diagnosis of dementia or stroke. During a mean follow-up of 7.3 ± 1.5 years, 9435 (2.2%) were diagnosed with dementia. Per 10 mmHg increase in systolic BP (SBP), risk of dementia was increased by 22% (95% confidence interval [CI] 1.15–1.30) in subjects aged 40–59 years and 8% (95% CI 1.04–1.11) in subjects aged 60–69 years. No significant associations were observed in subjects aged ≥ 70 years. Among subjects aged 40–59 years, both vascular and Alzheimer’s dementia risks were increased with increasing SBP. Increasing hypertension burden (proportion of days with increased BP) was associated with higher dementia risk (hazard ratio [HR] 1.09 per 10% increase, 95% CI 1.08–1.10). Among patients with baseline SBP ≥ 140 mmHg, optimal follow-up SBP (120–139 mmHg) was associated with decreased dementia risk (HR 0.69, 95% CI 0.50–0.95). Hypertension burden was associated with higher risks of dementia. Adequate BP control was associated with lower risk of dementia in individuals aged < 70 years.

Highlights

In this nationwide cohort study, we assessed the effects of hypertension burden and blood pressure (BP) control on dementia in different age subgroups
Population-based study, we investigated the associations of systolic (SBP) and diastolic BP (DBP) level and hypertension burden with dementia risk in wide range of age subgroups
Dementia according to the time in different BP group (Supplementary Fig. 1), the number of demented patients per age group and types of dementia diagnosed (Supplementary Table 3) and distribution of systolic BP (SBP) and DBP (Supplementary Fig. 2) are presented in online materials

Summary

Introduction

In this nationwide cohort study, we assessed the effects of hypertension burden and blood pressure (BP) control on dementia in different age subgroups. Among subjects aged [40–59] years, both vascular and Alzheimer’s dementia risks were increased with increasing SBP. Hypertension burden was associated with higher risks of dementia. Hypertension, which affects more than 75% of people > 65 years of age, has emerged as a potential modifiable risk factor for mild cognitive impairment and dementia in observational studies[3]. The association of hypertension with cognitive dysfunction and dementia has been suggested to differ based on age and follow-up duration and to contribute to lack of consensus. Population-based study, we investigated the associations of systolic (SBP) and diastolic BP (DBP) level and hypertension burden with dementia risk in wide range of age subgroups. Excluded (n=28,535) - Those who did not receive BP measurement at first health screening (n=162) - Those who had an ischemic stroke or transient ischemic attack before initial health checkup (n=22,694) - Those who had a hemorrhagic stroke before initial health checkup (n=1,140) - Those who were ever diagnosed as dementia before first health screening (n=503) - Patients aged ≥80 years (n=4,036)

Methods

Results

Conclusion