Abstract
BackgroundVascular dementia (VaD) is the second most common form of dementia. However, there were mixed evidences about the association between blood pressure (BP) and risk of VaD in midlife and late life and limited evidence on the association between pulse pressure and VaD.MethodsThis is a population-based observational study. 265,897 individuals with at least one BP measurement between the ages of 60 to 65 years and 211,116 individuals with at least one BP measurement between the ages of 70 to 75 years were extracted from The Health Improvement Network in United Kingdom. Blood pressures were categorized into four groups: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Cases of VaD were identified from the recorded clinical diagnoses. Multivariable survival analysis was used to adjust other confounders and competing risk of death. All the analysis were stratified based on antihypertensive drug use status. Multiple imputation was used to fill in missing values.ResultsAfter accounting for the competing risk of death and adjustment for potential confounders, there was an association between higher BP levels in the age 60–65 cohort with the risk of developing VaD (hazard ratio [HR] 1.53 (95% confidence interval: 1.04, 2.25) for prehypertension, 1.90 (1.30, 2.78) for stage 1 hypertension, and 2.19 (1.48, 3.26) for stage 2 hypertension) in the untreated group. There was no statistically significant association between BP levels and VaD in the treated group in the age 60–65 cohort and age 70–75 cohort. Analysis on Pulse Pressure (PP) stratified by blood pressure level showed that PP was not independently associated with VaD.ConclusionHigh BP between the ages of 60 to 65 years is a significant risk for VaD in late midlife. Greater efforts should be placed on early diagnosis of hypertension and tight control of BP for hypertensive patients for the prevention of VaD.
Highlights
Vascular dementia (VaD) is the second most common form of dementia
We explored the association of blood pressure and vascular dementia by estimating age and sex standardized incidence rates of 13 SBP categories and 7 diastolic blood pressure (DBP) categories
Incidence rate of vascular dementia We explored the association of systolic and diastolic blood pressure with vascular dementia by estimating the age and sex standardized incidence rate of vascular dementia for each category of SBP and DBP (Fig. 1)
Summary
Vascular dementia (VaD) is the second most common form of dementia. Hypertension and dementia are common disorders in the elderly. Among people aged 60 years and over, the prevalence is estimated to be around 5 to 7% for dementia and over 50% for hypertension [1, 2]. Vascular dementia (VaD) caused by a variety of vascular diseases is one of the most common forms of dementia [3]. The association between BP and dementia may be age dependent, [6, 7] with high BP at midlife (age 40–64 years) being associated with an increased risk for VaD [5, 8]. A history of hypertension at age 75 or over is not consistently a risk
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