Self-Reported Late-Life Hypertension Is Associated with a Healthy Cognitive Status and Reduced Alzheimer’s Disease Pathology Burden¹

Article type: Research Article

Authors: Robinson, Andrew C.^{a; b; *} | Bin Rizwan, Tawfique^c | Davidson, Yvonne S.^a | Minshull, James^a | Tinkler, Phillip^a | Payton, Antony^d | Mann, David M.A.^a | Roncaroli, Federico^{a; b}

Affiliations: [a] Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Neuroscience, The University of Manchester, Salford Royal Hospital, Salford, UK | [b] Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre (MAHSC), Manchester, UK | [c] Faculty of Biology, Medicine and Health, School of Medical Sciences, School of Health Sciences, The University of Manchester, Manchester, UK | [d] Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK

Correspondence: [*] Correspondence to: Dr Andrew C. Robinson, Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Neuroscience, The University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK. Tel.: +44 (0) 161 206 2580; E-mail: [email protected].

Note: [1] This article received a correction notice (Erratum) with the reference 10.3233/JAD-249010, available at http://doi.org/10.3233/JAD-249010.

Abstract: Background:While mid-life hypertension represents a risk factor for the development of Alzheimer’s disease (AD), the risk after the age of 65 is less certain. Establishing relationships between late life hypertension and the pathological changes of AD could be crucial in understanding the relevance of blood pressure as a risk factor for this disorder. Objective:We investigated associations between self-reported late-life hypertension, cognitive status and AD pathology at death. The impact of antihypertensive medication was also examined. Methods:Using the Cornell Medical Index questionnaire, we ascertained whether participants had ever reported hypertension. We also noted use of antihypertensive medication. The donated brains of 108 individuals were assessed for AD pathology using consensus guidelines. Statistical analysis aimed to elucidate relationships between hypertension and AD pathology. Results:We found no associations between self-reported hypertension and cognitive impairment at death. However, those with hypertension were significantly more likely to exhibit lower levels of AD pathology as measured by Thal phase, Braak stage, CERAD score, and NIA-AA criteria—even after controlling for sex, level of education and presence of APOE ɛ4 allele(s). No significant associations could be found when examining use of antihypertensive medications. Conclusions:Our findings suggest that late-life hypertension is associated with less severe AD pathology. We postulate that AD pathology may be promoted by reduced cerebral blood flow.

Keywords: Alzheimer’s disease, dementia, hypertension, neuropathology

DOI: 10.3233/JAD-231429

Journal: Journal of Alzheimer's Disease, vol. 98, no. 4, pp. 1457-1466, 2024