Blood pressure and risk of dementia and its subtypes: a historical cohort study with long-term follow-up in 2.6 million people.
Adult
Aged
Aged, 80 and over
Alzheimer Disease
/ epidemiology
Blood Pressure
/ physiology
Blood Pressure Determination
Cohort Studies
Databases, Factual
Dementia
/ epidemiology
Dementia, Vascular
/ epidemiology
Female
Follow-Up Studies
Humans
Hypertension
/ complications
Incidence
Male
Middle Aged
Risk
Alzheimer's disease
dementia
epidemiology
hypertension
vascular dementia
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
06
12
2018
accepted:
18
06
2019
pubmed:
25
6
2019
medline:
1
7
2020
entrez:
25
6
2019
Statut:
ppublish
Résumé
Elevated blood pressure (BP) is prevalent and modifiable and has been hypothesized to lead to increased risk of dementia. Data on 2 593 629 people from the UK Clinical Practice Research Database aged ≥40 years with a BP measurement between 1992 and 2011 and no prior record of dementia were collected. Poisson regression models were used to study the association between BP and physician-diagnosed dementia. BP is believed to fall during the prodromal phase of dementia development, so associations were investigated by categories of time since BP measurement (<5, 5-10, >10 years) and by subtypes of dementia. During a median follow-up of 8.2 years, 65 618 cases of dementia were observed: 49 161 Alzheimer's, 13 816 vascular dementia and 2541 other subtypes. For each 10 mmHg higher systolic BP, the future dementia risk was 9.2% (95% confidence interval 8.4%-10.0%) lower, but this association varied markedly by time since BP measurement. Short-term associations with dementia were inverse with a 15.8% (15.5%-17.0%) lower risk 0-5 years after BP measurement and a 5.8% (7.7%-4.4%) lower risk 5-10 years after BP measurement. During the period >10 years after BP measurement, dementia risk was only 1.6% (0.1%-3.0%) lower, with a 4.3% (2.5%-6.0%) lower risk of Alzheimer's disease and a 7.0% (3.8%-10.2%) higher risk of vascular dementia. Elevated BP is associated with decreased risk of dementia in the short term, possibly due to reverse causation. Long-term associations of BP with dementia are less marked and differ by dementia subtype.
Sections du résumé
BACKGROUND AND PURPOSE
Elevated blood pressure (BP) is prevalent and modifiable and has been hypothesized to lead to increased risk of dementia.
DATA
Data on 2 593 629 people from the UK Clinical Practice Research Database aged ≥40 years with a BP measurement between 1992 and 2011 and no prior record of dementia were collected.
METHODS
Poisson regression models were used to study the association between BP and physician-diagnosed dementia. BP is believed to fall during the prodromal phase of dementia development, so associations were investigated by categories of time since BP measurement (<5, 5-10, >10 years) and by subtypes of dementia.
RESULTS
During a median follow-up of 8.2 years, 65 618 cases of dementia were observed: 49 161 Alzheimer's, 13 816 vascular dementia and 2541 other subtypes. For each 10 mmHg higher systolic BP, the future dementia risk was 9.2% (95% confidence interval 8.4%-10.0%) lower, but this association varied markedly by time since BP measurement. Short-term associations with dementia were inverse with a 15.8% (15.5%-17.0%) lower risk 0-5 years after BP measurement and a 5.8% (7.7%-4.4%) lower risk 5-10 years after BP measurement. During the period >10 years after BP measurement, dementia risk was only 1.6% (0.1%-3.0%) lower, with a 4.3% (2.5%-6.0%) lower risk of Alzheimer's disease and a 7.0% (3.8%-10.2%) higher risk of vascular dementia.
CONCLUSIONS
Elevated BP is associated with decreased risk of dementia in the short term, possibly due to reverse causation. Long-term associations of BP with dementia are less marked and differ by dementia subtype.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1479-1486Subventions
Organisme : Medical Research Council
ID : G0802403
Pays : United Kingdom
Informations de copyright
© European Academy of Neurology 2019.
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