Blood pressure trajectories from early life and their association with cognitive function changes in midlife

Abstract Background Hypertension (HTN) is a well‐established risk factor for cognitive impairment and dementia. HTN‐induced vascular endothelium and smooth muscle damage have been described as pivotal components of the pathophysiological cascade over the life‐course. While the impact on cognitive function (CF) changes has been studied from midlife‐ to old age, the impact from childhood to middle age exposure remains poorly understood. We aimed to explore this relationship in a community‐based cohort of middle‐age adults. Methods The analysis included a total of 342 adult participants (67.3% Woman, 38.9% African American) from the Bogalusa Heart Study, with CF assessments at two time points, baseline (age 48.8 ± 4.9 years) and follow‐up (age 51.7 ± 5.2 years), and at least 3 observations of BP since childhood. CF change was assessed by computing the difference of the two timepoints standardized global cognitive score (GCS) obtained from a battery of tests covering major neuropsychological domains. Systolic BP (SBP) trajectories were created using latent class trajectory modeling. Mixed linear models with unstructured covariance were used to determine the association between SBP trajectories and CF changes in midlife. Results Mean CF assessment follow‐up was 2.9 ± 0.6 years, and mean follow‐up for BP and other traditional cardiovascular (CV) risk factors was 41.8 ± 3.4 years. Three distinct trajectory classes of SBP were identified: increasing to plateau (n=226 [66.1%]), moderate‐ (n=54 [15.8%]) and high‐ (n=62 [18.1%]) increasing (see Figure 1). With the increasing to plateau SBP trajectory as reference, and after adjustment for modifiable dementia risk factors and traditional CV risk factors, the high‐increasing SBP trajectory was associated with greater decrease in GCS (β= ‐1.22 [95%CI ‐2.39, ‐0.07]; p =0.038). The moderate‐increasing SBP trajectory showed no statistically significant association with GCS change (β= ‐1.00 [95%CI ‐2.23, ‐ 0.22]; p =0.109). (see Table 1) Conclusions These findings suggest that highly‐increasing SBP trajectories over time, particularly from childhood to mid‐ life, may adversely affect cognitive performance in midlife, independent of modifiable dementia risk factors. This underscores the importance of addressing CV risk factors during childhood and adolescence through primary prevention, as their cumulative burden could have a detrimental impact on brain health.