JAMANEUROLOGY Midlife Hypertension and 20-Year Cognitive Change: The Atherosclerosis Risk in Communities Neurocognitive Study

Along with declining memory performance, elevation of systolic blood pressure and an increased prevalence of hypertension are expected consequences of advancing age. It is not surprising, therefore, to expect that the two processes may be related. In 1987, Inzitari et al1 first identified brain injury and subtle cognitive impairment associated with elevated levels of systolic blood pres-sure (SBP). In 1995, Launer et al2 found that elevations in middle-life blood pressure were associated with reduced cognitive func-tion in later life. Many studies subsequently confirmed and extended research related to the relationships among middle-life blood pressure, brain injury, and cognitive function among community-living individuals, suggesting that the inverse rela-tionship between middle-life blood pressure and reduced cogni-tive ability is nearly universal. Using a twin study design, Swan et al3 also confirmed the association betweenmiddle-life patterns of SBP and cognition and identified that the cognitive differences were likely mediated by brain injury related to the level of middle-life blood pressure