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BACKGROUND:Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure. AIMS:To examine lifetime blood pressure as a predictor of brain structure in old age. METHOD:A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities. RESULTS:Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy. CONCLUSIONS:Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose-response pattern.

Original publication

DOI

10.1192/bjp.bp.114.153536

Type

Journal article

Journal

The British journal of psychiatry : the journal of mental science

Publication Date

04/2015

Volume

206

Pages

308 - 315

Addresses

Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.

Keywords

Brain, Humans, Dementia, Hypertension, Atrophy, Magnetic Resonance Imaging, Radionuclide Imaging, Risk Factors, Cohort Studies, Follow-Up Studies, Cross-Sectional Studies, Cognition Disorders, Depressive Disorder, Age Distribution, Sex Distribution, Blood Pressure, Aged, Aged, 80 and over, Middle Aged, Female, Male