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Vol. 26, No. 1, 2006
Issue release date: December 2005
Neuroepidemiology 2006;26:30–36

Relation of Blood Pressure to Risk of Incident Alzheimer’s Disease and Change in Global Cognitive Function in Older Persons

Shah R.C. · Wilson R.S. · Bienias J.L. · Arvanitakis Z. · Evans D.A. · Bennett D.A.
aRush Alzheimer’s Disease Center, bRush Institute for Healthy Aging, and Departments of cNeurological Sciences, dFamily Medicine, ePsychology, and fInternal Medicine, Rush University Medical Center, Chicago, Ill., USA

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Purpose: To examine the relation of systolic and diastolic blood pressure to incident Alzheimer’s disease (AD) and rate of cognitive change. Methods: Longitudinal cohort study with annual clinical evaluations. At baseline, blood pressure was measured, apolipoprotein E (APOE) genotyping was performed, and medications were reviewed. Results: 824 older Catholic clergy members without baseline dementia were recruited from across the United States. During a mean of about 6 years of observation, 151 persons developed AD. In a proportional hazards model adjusted for age, sex and education, neither systolic (relative risk = 0.995; 95% CI: 0.986, 1.004, p = 0.249) nor diastolic (relative risk = 1.000; 95% CI: 0.985, 1.015, p = 0.975) blood pressure was related to AD incidence. In mixed effects models, neither systolic nor diastolic blood pressure was related to level or to annual rate of change on a global measure of cognition. These results did not change in subsequent models that accounted for the use of medications with antihypertensive properties or for the possession of an APOE ε4 allele. Conclusions: In a cohort of older persons with a majority taking medications with antihypertensive properties, we did not find a relationship between blood pressure and risk of AD or cognitive decline.

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  1. Kivipelto M, Helkala E-L, Laakso MP, Hanninen T, Hallikainen M, Alhainen K, Soininen H, Tuomilehto J, Nissien A: Midlife vascular risk factors and Alzheimer’s disease in later life: longitudinal, population based study. BMJ 2001;322:1447–1451.
  2. Launer LJ, Ross GW, Petrovitch H, Masaki K, Foley D, White LR, Havlik RJ: Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000;21:49–55.
  3. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ: Low blood pressure and the risk of dementia in very old individuals. Neurology 2003;61:1667–1672.
  4. Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson L-A, Nilsson L, Persson G, Oden A, Svanborg A: 15-year longitudinal study of blood pressure and dementia. Lancet 1996;347:1141–1145.
  5. Guo Z, Viitanen M, Winblad B, Fratiglioni L: Low blood pressure and incidence of dementia in a very old sample: dependent on initial cognition. J Am Geriatr Soc 1999;47:723–726.
  6. Posner HB, Tang M-X, Luchsinger J, Lantigua R, Stern Y, Mayeux R: The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology 2002;58:1175–1181.
  7. Morris MC, Scherr PA, Hebert LE, Glynn RJ, Bennett DA, Evans DA: Association of incident Alzheimer disease and blood pressure measured from 13 years before to 2 years after diagnosis in a large community study. Arch Neurol 2001;58:1640–1646.
  8. Forette F, Seux ML, Staessen JA, Thijs L, Babarskiene MR, Babeanu S, Bossini A, Fagard R, Gil-Extremera B, Laks T, Kobalava Z, Sarti C, Tuomilehto J, Vanhanen H, Webster J, Yodfat Y, Birkenhager WH: The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) Study. Arch Intern Med 2002;162:2046–2052.
  9. Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Filenbaum G, Heyman A: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V: A normative study of the neuropsychological battery. Neurology 1994;44:609–614.
  10. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984;34:939–944.
  11. Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  12. Weschler D: Wechsler Memory Scale: Revised Manual. San Antonio, Psychological Corp, 1987.
  13. Albert M, Smith L, Scherr P, Taylor JO, Evans DA, Funkenstein HH: Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer’s disease. Int J Neurosci 1991;57:167–178.
  14. Kaplan EF, Goodglass H, Weintraub S: The Boston Naming Test. Philadelphia, Lea & Febiger, 1983.
  15. Ekstrom RB, French FW, Harman HH, Kerman D: Manual for kit of factor-referenced cognitive tests. Princeton, Educational Testing Service, 1976.
  16. Nelson HE: National Adult Reading Test (NART) Manual. Windsor, NFER-Nelson, 1982.
  17. Cooper JA, Sager HJ: Incidental and intentional recall in Parkinson’s disease: an account based on diminished attentional resources. J Clin Exp Neuropsychol 1993;15:713–731.
  18. Craik FIM: A functional account of age differences in memory: in Klix E, Hagendorf H (eds): Human Memory and Cognitive Capabilities: Mechanisms and Performances. Amsterdam, Elsevier Science Publishers BV, 1986, pp 409–422.
  19. Smith A: Symbol Digit Modalities Test Manual, revised. Los Angeles, Western Psychological Services, 1982.
  20. Benton AL, Sivan AB, Hamsher K, Varney NR, Spreen O: Contributions to Neuropsychological Assessment, ed 2. New York, Oxford University Press, 1994.
  21. Raven JC, Court JH, Raven J: Manual for Raven’s Progressive Matrices and Vocabulary: Standard Progressive Matrices. Oxford, Oxford Psychologists Press, 1992.
  22. SAS Institute Inc: SAS/STAT® User’s Guide, version 8. Cary, SAS Institute,2000.
  23. Bennett DA, Wilson RS, Schneider JA, Evans DA, Beckett LA, Aggarwal NT, Barnes LL, Fox JH, Bach J: Natural history of mild cognitive impairment in older persons. Neurology 2002;59:198–205.
  24. Wilson RS, Beckett LA, Barnes LL, Schneider JA, Bach J, Evans DA, Bennett DA: Individual differences in rates of change in cognitive abilities of older persons. Psychol Aging 2002;17:179–193.
  25. Wilson RS, Bienias JL, Berry-Kravis E, Evans DA, Bennett DA: The apolipoprotein E e2 allele and decline in episodic memory. J Neurol Neurosurg Psychiatry 2002;73:672–677.
  26. Hypertension Detection and Follow-Up Program Cooperative Group: Race, education, and prevalence of hypertension. Am J Epidemiol 1977;106:351–361.

    External Resources

  27. Morris MC, Scherr PA, Hebert LE, Bennett DA, Wilson RS, Glynn RJ, Evans DA: The cross-sectional association between blood pressure and Alzheimer’s disease in a biracial community population of older persons. J Gerontol A Biol Sci Med Sci 2000;55:M130–M136.
  28. Anonymous: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 2004. NIH Publication No 04–5230.
  29. Hixson J, Vernier DO: Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with Hha I. J Lipid Res 1990;31:545–548.
  30. Wenham PR, Price WH, Blundell G: Apolipoprotein E genotyping by one-stage PCR. Lancet 1991;337:1158–1159.
  31. Cox DR: Regression models and life tables (with discussion). J R Stat Soc B 1972;74:187–220.
  32. Laird N, Ware J: Random-effects models for longitudinal data. Biometrics 1982;38:963–973.
  33. Wilson RS, Gilley DW, Bennett DA, Beckett LA, Evans DA: Person-specific paths of cognitive decline in Alzheimer’s disease and their relation to age. Psychol Aging 2000;15:18–28.
  34. Qiu C, Winblad B, Fastbom J, Fratiglioni L: Combined effects of APOE genotype, blood pressure, and antihypertensive drug use on incident AD. Neurology 2003;61:655–660.
  35. Corder EH, Saunders AM, Strittmatter WJ, Schmechel DE, Gaskell PC, Small GW, Roses AD, Haines JL, Pericak-Vance MA: Gene dose of apolipoprotein E type 4 and the risk of Alzheimer’s disease in late onset families. Science 1993;261:921–3.
  36. Tsai MS, Tangalos EG, Petersen RC, Smith GE, Schaid DJ, Kokmen E, Ivnik RJ, Thibodeau SN: Apolipoprotein E: risk factor for Alzheimer’s disease. Am J Hum Genet 1994;54:643–649.
  37. Myers RH, Schaefer EJ, Wilson PW, D’Agostino R, Ordovas JM, Espino A, Au R, White RF, Knoefel JE, Cobb JL, McNulty KA, Beiser A, Wolf PA: Apolipoprotein E epsilon 4 association with dementia in a population-based study: The Framingham Study. Neurology 1996;46:673–677.
  38. Hebert LE, Scherr PA, Bennett DA, Bienias JL, Wilson R, Morris MC, Evans DA: Blood pressure and change in cognitive function in late life: a biracial longitudinal population study. Neurology 2004;62:2021–2024.
  39. Glynn RJ, Beckett LA, Hebert LE, Morris MC, Scherr PA, Evans DA: Current and remote blood pressure and cognitive decline. JAMA 1999;281:438–445.
  40. Guo Z, Fratiglioni L, Windblad B, Viitanen M: Blood pressure and performance on the Mini-Mental State Examination in the very old: cross-sectional and longitudinal data from the Kungshomen Project. Am J Epidemiol 1997;145:1106–1113.
  41. Tzourio C, Dufouil C, Ducimetiere P, Alperovitch A: Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. Neurology 1999;53:1948–1952.
  42. Kochanek KD, Murphy SL, Anderson RN, Scott C: Deaths: final data for 2002, table 3. Natl Vital Stat Rep 2004;53:21.
  43. Launer LJ, Masaki K, Petrovitch H, Foley D, Havalik RJ: The association between midlife blood pressure levels and late-life cognitive function: the Honolulu-Asia Aging Study. JAMA 1995;274:1846–1851.
  44. Carmelli D, Swan GE, Reed T, Miller B, Wolf PA, Jarvik GP, Schellenberg GD: Midlife cardiovascular risk factors, ApoE, and cognitive decline in elderly male twins. Neurology 1998;50:1580–1585.
  45. Elias MF, Wolf PA, D’Agostino RB, Cobb J, White LR: Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol 1993;138:353–364.
  46. Elias MF, Robbins MA, Elias PK, Streeten DHP: A longitudinal study of blood pressure in relation to performance on the Wechsler Adult Intelligence Scale. Health Psychol 1998;17:486–493.
  47. Kilander L, Nyman H, Boberg M, Lithell H: The association between low diastolic blood pressure in middle age and cognitive function in old age: a population-based study. Age Ageing 2000;29:243–248.
  48. Swan GE, Carmelli D, Larue A: Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults. Stroke 1998;29:2334–2340.
  49. SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265:3255–3264.

    External Resources

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