Dementia in older women linked to hypertension earlier in life

Hypertension may put women at greater risk for dementia later in life by increasing white matter abnormalities in the brain, a new study suggested.

The analysis included 1,403 women aged 65 years or older included in the multicenter, long-term Women’s Health Initiative Memory Study; 883 had been randomized in the conjugated equine estrogen plus medroxyprogesterone acetate study (436 active; 447 placebo) and 520 had been randomized in the conjugated equine estrogens alone study (257 active; 263 placebo).

All participants had their BP assessed annually and underwent brain MRI. Researchers assessed white matter lesions, which are associated with increased risks for dementia and stroke.

Women who were hypertensive at baseline (31%; ≥140 mm Hg/90 mm Hg) had significantly more white matter lesions on their MRI scans eight years later compared with women who had normal BP. Lesions were most common at the frontal lobe than in the occipital, parietal or temporal lobes.

Women taking antihypertensive therapy had greater white matter lesion volumes compared with women not taking antihypertensive therapy (P=.03).

When the researchers repeated the analysis based on late on-trial BP data and antihypertensive medication status, white matter lesion volumes remained significantly related to baseline BP levels for women not taking antihypertensive drugs, but not for women taking antihypertensive drugs.

“Proper control of BP, which remains generally poor, may be very important to prevent dementia as women age,” researcher Lewis Kuller, MD, DrPH, professor of epidemiology, University of Pittsburgh Graduate School of Public Health, said in a press release. “Women should be encouraged to control high BP when they are young or in middle-age in order to prevent serious problems later on.”

The research was funded by grants from the National Institutes of Health’s National Heart, Lung, and Blood Institute and the U.S. Department of Health and Human Services.

Kuller LH. J Clin Hypertens. 2009;doi:10.1111/j.1751-7176.2009.00234.x.