TY - JOUR
T1 - Association between Blood Pressure and Later-Life Cognition among Black and White Individuals
AU - Levine, Deborah A.
AU - Gross, Alden L.
AU - Briceño, Emily M.
AU - Tilton, Nicholas
AU - Kabeto, Mohammed U.
AU - Hingtgen, Stephanie M.
AU - Giordani, Bruno J.
AU - Sussman, Jeremy B.
AU - Hayward, Rodney A.
AU - Burke, James F.
AU - Elkind, Mitchell S.V.
AU - Manly, Jennifer J.
AU - Moran, Andrew E.
AU - Kulick, Erin R.
AU - Gottesman, Rebecca F.
AU - Walker, Keenan A.
AU - Yano, Yuichiro
AU - Gaskin, Darrell J.
AU - Sidney, Stephen
AU - Yaffe, Kristine
AU - Sacco, Ralph L.
AU - Wright, Clinton B.
AU - Roger, Veronique L.
AU - Allen, Norrina Bai
AU - Galecki, Andrzej T.
N1 - Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline. Design, Setting, and Participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018. Main Outcomes and Measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function. Exposures: Race (black vs white). Results: Among 34349 participants, 19378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19378 individuals, 10724 (55.3%) were female and 15526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P =.004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P <.001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P <.001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P <.001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P <.001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P <.001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P =.56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P <.001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P <.001). Conclusions and Relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.
AB - Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline. Design, Setting, and Participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018. Main Outcomes and Measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function. Exposures: Race (black vs white). Results: Among 34349 participants, 19378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19378 individuals, 10724 (55.3%) were female and 15526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P =.004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P <.001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P <.001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P <.001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P <.001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P <.001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P =.56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P <.001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P <.001). Conclusions and Relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.
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U2 - 10.1001/jamaneurol.2020.0568
DO - 10.1001/jamaneurol.2020.0568
M3 - Article
C2 - 32282019
AN - SCOPUS:85083266633
SN - 2168-6149
VL - 77
SP - 810
EP - 819
JO - JAMA neurology
JF - JAMA neurology
IS - 7
ER -