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(Hypertension. 2004;44:29.)
© 2004 American Heart Association, Inc.

Scientific Contributions

Midlife Blood Pressure and the Risk of Hippocampal Atrophy

The Honolulu Asia Aging Study

Esther S.C. Korf; Lon R. White; Philip Scheltens; Lenore J. Launer

From the Department of Neurology and Alzheimer Center (E.S.C.K., P.S.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Pacific Health Research Institute (L.R.W.), Honolulu, Hawaii; and the Laboratory of Epidemiology, Demography, and Biometry (L.J.L.), National Institute on Aging, National Institutes of Health, Bethesda, Md.

Correspondence to L.J. Launer, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave, Suite 3C-309, Bethesda, MD 20892. E-mail launerl{at}nia.nih.gov

Hippocampal atrophy (HA) is usually attributed to the neurofibrillary tangles and neuritic plaques of Alzheimer disease. However, the hippocampus is vulnerable to global ischemia, which may lead to atrophy. We investigated the association of midlife blood pressure (BP) and late-life HA in a sample of Japanese-American men born between 1900 and 1919. BP was measured on 3 occasions between 1965 and 1971. In 1994 to 1996 a subsample underwent magnetic resonance imaging (MRI) of the brain. Hippocampal volume was estimated by manually drawing regions of interest on relevant scan slices; HA was defined as the lowest quartile of hippocampal volume. Also assessed on the MRI were cortical and subcortical infarcts, lacunes, and white matter hyperintensities. The risk (OR, 95% CI) was estimated for HA associated with systolic (<140 versus 140 mm Hg) and diastolic (<90 versus 90 mm Hg) BP and with antihypertensive treatment. Analyses were adjusted for sociodemographic factors, other cardiovascular risk factors, apolipoprotein E allele, and correlated brain pathology. Those never treated with antihypertensive medication had a significantly increased risk for HA (OR 1.7; CI=1.12; 2.65). The nontreated subjects with high systolic BP had an increased risk (OR=1.98; CI=0.89; 4.39) for HA. Results were similar for untreated men with high diastolic BP (OR=3.51; CI=1.26; 9.74). In conclusion, treatment with antihypertensive treatment modifies the association of BP and HA, such that high levels of BP adversely affect the hippocampus in persons never treated with antihypertensives.

Key Words: blood pressure • magnetic resonance imaging • epidemiology • brain

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