High BP in young adulthood tied to midlife brain changes

Having high blood pressure (BP) during age 20-40 years appears to be associated with brain changes in midlife which may increase the risk of cognitive decline in later life, according to data from the Coronary Artery Risk Development in Young Adults (CARDIA) study presented at ISC 2022.

“There are studies to suggest changes to the brain may start at a young age,” said lead author Dr Christina Lineback from Northwestern Memorial Hospital in Chicago, Illinois, US. “Our study provides further evidence that high BP during young adulthood may contribute to changes in the brain later in life.”

The findings suggest that healthcare professionals should consider more aggressive treatment for high BP in younger adults to guard against potentially detrimental brain changes in later life.

In the longitudinal study, 142 participants (42 percent women) with brain MRI data available at 30 years old from the CARDIA cohort were included in the analysis. They were followed up over 30 years on vascular risk factors such as cumulative BP, glucose levels, cholesterol, BMI, and smoking status. Only findings on cumulative BP were reported here. All participants subsequently underwent another MRI at midlife (around age 55 years). [ISC 2022, abstract WMP19]

Higher cumulative systolic BP was associated with lower total brain volume (p=0.023), as well as lower volumes of grey matter (p=0.031) and hippocampus (p<0.001) in midlife among African Americans, but not among Caucasians. 

Similarly, lower total brain volume (p=0.049) and hippocampal volume (p=0.002) in midlife were seen with higher cumulative diastolic BP during young adulthood. Again, the association was significant only in African Americans, but not in Caucasians. 

However, the differences between races were no longer significant after accounting for the degree of high BP exposure — ie, the brain changes that occurred were similarly seen across all races when the analysis was stratified by cumulative BP exposure levels.

“We were surprised that we could see brain changes in even this small sample of participants from the CARDIA study,” Lineback noted.

There were no significant interactions between race and cerebral perfusion, white matter hyperintensities, or grey matter thickness (interaction p>0.05).

“Given the greater likelihood of high BP in some racial and ethnic groups, this study’s finding should encourage healthcare professionals to aggressively address high BP in young adults, as a potential target to narrow disparities in brain health,” Lineback pointed out.