Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort

• Type of Material: Article
• Authors: Jeffrey D. Hodis, Emory University; Rebecca F. Gottesman, Johns Hopkins University; B. Gwen Windham, University of Mississippi; David S. Knopman, Mayo Clinic; Pamela L. Lutsey, University of Minnesota; Keenan A. Walker, Johns Hopkins University; Alvaro Alonso, Emory University
• Language: English
• Date: 2020-11-17
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.120.017546
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 9
• Issue: 22
• Start Page: e017546
• End Page: e017546
• Grant/Funding Information: The ARIC (Atherosclerosis Risk in Communities) Study is performed as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). Neurocognitive data are collected by 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, and 2U01HL096917 from the National Institutes of Health, and with previous brain magnetic resonance imaging examinations funded by R01‐HL70825 from the NHLBI. Research reported in this publication was additionally supported by the NHLBI of the National Institutes of Health under award K24HL148521. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: ATHEROSCLEROSIS RISK; Cardiac & Cardiovascular Systems; hypertension; epidemiology; Cardiovascular System & Cardiology; LIFE; dementia; VASCULAR RISK-FACTORS; population attributable fraction; Life Sciences & Biomedicine; Science & Technology; practice guideline; DIAGNOSIS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Biology, Neuroscience

Abstract

BACKGROUND: The impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated. METHODS AND RESULTS: We studied dementia-free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2. CONCLUSIONS: Risk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.