Early-onset hypertension poses risk of cognitive decline in midlife

Individuals who develop early-onset hypertension are at higher risk of developing cognitive impairment in midlife relative to those with late-onset, a study suggest.

The analysis used data from the CARDIA study (Coronary Artery Risk Development in Young Adults) and included 2,946 participants (mean age, 55 years; 57 percent female). All participants underwent nine repeat examinations, including blood pressure measurements, between 1985–1986 and 2015–2016.

Cognitive function was evaluated at the year 30 exam using brain magnetic resonance imaging and completed Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop interference test, and the Montreal Cognitive Assessment.

Results for cognitive function were significantly different between participants with early-onset hypertension and those with normal blood pressure levels. In particular, standardized Z-scores in individuals with early-onset hypertension (onset at <35 years) were lower by 0.24±0.09 for Digit Symbol Substitution Test, 0.22±0.10 for Stroop test, 0.27±0.09 for Montreal Cognitive Assessment, and 0.19±0.07 for the composite cognitive score (p<0.05 for all).

On the other hand, hypertension onset at ≥35 years showed no association with cognitive function in midlife (p>0.05 for all).

In a subgroup of 559 participants, neither early- nor late-onset hypertension was associated with macrostructural brain alterations (p>0.05 for all).

The present data suggest that early-onset hypertension is a potent risk factor for midlife cognitive impairment. Age of hypertension onset assessment should be included in clinical practice as this could improve risk stratification of cognitive decline among hypertensive patients.