Blood Pressure and Later-Life Cognition in Hispanic and White Adults (BP-COG): A Pooled Cohort Analysis of ARIC, CARDIA, CHS, FOS, MESA, and NOMAS¹

Article type: Research Article

Authors: Levine, Deborah A.^{a; b; c} | Gross, Alden L.^d | Briceño, Emily M.^{a; e} | Tilton, Nicholas^a | Whitney, Rachael^a | Han, Dehua^a | Giordani, Bruno J.^f | Sussman, Jeremy B.^{a; c; g} | Hayward, Rodney A.^{a; c; g} | Burke, James F.^{b; c; g} | Elkind, Mitchell S.V.^{h; i} | Moran, Andrew E.^j | Tom, Sarahⁱ | Gottesman, Rebecca F.^k | Gaskin, Darrell J.^l | Sidney, Stephen^m | Yaffe, Kristineⁿ | Sacco, Ralph L.^o | Heckbert, Susan R.^p | Hughes, Timothy M.^q | Lopez, Oscar L.^r | Allen, Norrina Bai^s | Galecki, Andrzej T.^{a; t}

Affiliations: [a] Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA | [b] Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA | [c] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA | [d] Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, MD, USA | [e] Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA | [f] Department of Psychiatry & Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA | [g] VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [h] Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA | [i] Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA | [j] Department of Medicine, Division of General Medicine, Columbia University, New York, NY, USA | [k] Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA | [l] Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA | [m] Kaiser Permanente Northern California Division of Research, Oakland, CA, USA | [n] Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, San Francisco, CA, USA | [o] Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA | [p] Department of Epidemiology, University of Washington, Seattle, WA, USA | [q] Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA | [r] University of Pittsburgh, Pittsburgh, PA, USA | [s] Department of Internal Medicine, Northwestern University, Chicago, IL, USA | [t] Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

Correspondence: [*] Correspondence to: Deborah A. Levine, MD, MPH, University of Michigan Division of General Medicine, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA. Tel.: +1 734 936 5216; E-mail: [email protected].

Note: [1] This article received a correction notice (Erratum) with the reference: 10.3233/JAD-229021, available at http://doi.org/10.3233/JAD-229021.

Abstract: Background:Ethnic differences in cognitive decline have been reported. Whether they can be explained by differences in systolic blood pressure (SBP) is uncertain. Objective:Determine whether cumulative mean SBP levels explain differences in cognitive decline between Hispanic and White individuals. Methods:Pooled cohort study of individual participant data from six cohorts (1971–2017). The present study reports results on SBP and cognition among Hispanic and White individuals. Outcomes were changes in global cognition (GC) (primary), executive function (EF) (secondary), and memory standardized as t-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1 SD difference in cognition. Median follow-up was 7.7 (Q1–Q3, 5.2–20.1) years. Results:We included 24,570 participants free of stroke and dementia: 2,475 Hispanic individuals (median age, cumulative mean SBP at first cognitive assessment, 67 years, 132.5 mmHg; 40.8% men) and 22,095 White individuals (60 years,134 mmHg; 47.3% men). Hispanic individuals had slower declines in GC, EF, and memory than White individuals when all six cohorts were examined. Two cohorts recruited Hispanic individuals by design. In a sensitivity analysis, Hispanic individuals in these cohorts had faster decline in GC, similar decline in EF, and slower decline in memory than White individuals. Higher time-varying cumulative mean SBP was associated with faster declines in GC, EF, and memory in all analyses. After adjusting for time-varying cumulative mean SBP, differences in cognitive slopes between Hispanic and White individuals did not change. Conclusion:We found no evidence that cumulative mean SBP differences explained differences in cognitive decline between Hispanic and White individuals.

Keywords: Blood pressure, cognition, dementia, ethnic groups, Hispanic Americans

DOI: 10.3233/JAD-220366

Journal: Journal of Alzheimer's Disease, vol. 89, no. 3, pp. 1103-1117, 2022