Female sex, early-onset hypertension, and risk of dementia

Paola Gilsanz, Elizabeth Rose Mayeda, M. Maria Glymour, Charles P. Quesenberry, Dan M Mungas, Charles DeCarli, Alexander Dean, Rachel Whitmer

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women.

METHODS: We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978-1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up.

RESULTS: A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25-2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24-2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.

CONCLUSIONS: Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.

Original languageEnglish (US)
Pages (from-to)1886-1893
Number of pages8
JournalNeurology
Volume89
Issue number18
DOIs
StatePublished - Oct 31 2017

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Dementia
Hypertension
Integrated Delivery of Health Care
Confidence Intervals
Blood Pressure
Health Surveys
Proportional Hazards Models
Sex Characteristics
Blood Vessels
Comorbidity
Demography
Incidence
Health
Brain

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Female sex, early-onset hypertension, and risk of dementia. / Gilsanz, Paola; Mayeda, Elizabeth Rose; Glymour, M. Maria; Quesenberry, Charles P.; Mungas, Dan M; DeCarli, Charles; Dean, Alexander; Whitmer, Rachel.

In: Neurology, Vol. 89, No. 18, 31.10.2017, p. 1886-1893.

Research output: Contribution to journalArticle

Gilsanz, P, Mayeda, ER, Glymour, MM, Quesenberry, CP, Mungas, DM, DeCarli, C, Dean, A & Whitmer, R 2017, 'Female sex, early-onset hypertension, and risk of dementia', Neurology, vol. 89, no. 18, pp. 1886-1893. https://doi.org/10.1212/WNL.0000000000004602
Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Mungas DM, DeCarli C et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017 Oct 31;89(18):1886-1893. https://doi.org/10.1212/WNL.0000000000004602
Gilsanz, Paola ; Mayeda, Elizabeth Rose ; Glymour, M. Maria ; Quesenberry, Charles P. ; Mungas, Dan M ; DeCarli, Charles ; Dean, Alexander ; Whitmer, Rachel. / Female sex, early-onset hypertension, and risk of dementia. In: Neurology. 2017 ; Vol. 89, No. 18. pp. 1886-1893.
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AU - Mayeda, Elizabeth Rose

AU - Glymour, M. Maria

AU - Quesenberry, Charles P.

AU - Mungas, Dan M

AU - DeCarli, Charles

AU - Dean, Alexander

AU - Whitmer, Rachel

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N2 - OBJECTIVE: To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women.METHODS: We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978-1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up.RESULTS: A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25-2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24-2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.CONCLUSIONS: Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.

AB - OBJECTIVE: To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women.METHODS: We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978-1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up.RESULTS: A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25-2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24-2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.CONCLUSIONS: Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.

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