Blood pressure is associated with advanced brain aging patterns on MRI in midlife: The CARDIA Study

Abstract

AbstractBackgroundHigh blood pressure has been associated with cognitive outcomes such as dementia. Most studies have focused on blood pressure in mid or late life, thus this association in early adulthood is undefined. We aimed to investigate the relationship between sub‐clinical blood pressure in early adulthood and brain aging in midlife.MethodFrom the prospective study of Coronary Artery Risk Development in Young Adults, 662 Black and White participants were identified with follow‐up of 30 years (age 18–30 years at baseline) and brain MRI at Year 30. Cumulative exposure of systolic and diastolic blood pressure (BP) from baseline through Year 30 were estimated by areas under the curve and analyzed as time‐weighted averages. We used a previously‐validated high dimensional machine learning pattern analysis method to derive brain aging indices that quantify individual differences in spatial patterns of age‐related atrophy: the SPARE‐BA index (Spatial Pattern of Atrophy for Recognition of Brain Aging). Cognitive function was assessed at year 30 with the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), Stroop Test, and Verbal Fluency. We used linear regression models to estimate the associations between cumulative BP and predicted brain age and cognitive function at year 30.ResultCumulative systolic and diastolic BP were positively associated with higher predicted brain age (β: 0.10, 95% CI: 0.04‐0.17, β: 0.10, 95% CI: 0.02‐0.19, respectively), adjusted for chronological age at year 30, sex, education, and race. Participants with cumulative systolic or diastolic BP over the recommended guidelines (systolic BP>120, diastolic BP>80), had on average 3‐years older predicted brain age (95% CI: 1.00‐4.67; 95% CI: 1.45‐5.13, respectively), compared to those with normal levels. Moreover, higher predicted brain age was associated with poorer performance on the RAVLT (p= 0.009), DSST (p<0.001), Stroop Test (p<0.001) and Verbal Fluency (0.009).ConclusionElevated blood pressure from early to middle adulthood, especially above recommended guidelines, is associated with worse cognition in midlife and advanced brain aging. Elevated sub‐clinical blood pressure could be an important target for early intervention in order to prevent cognitive impairment.