Protect Your Brain Now. Hypertension in your 30s means worse brain health later

If you’ve got high blood pressure as a young adult, don’t wait to get it under control. A new UC Davis study finds that individuals in their 30s with hypertension have worse brain health in their mid-70s.

Published in JAMA Network Open, the study evaluated MRI brain scans of older adults that had high blood pressure between the ages of 30 to 40 with older, normotensive adults.

The researchers discovered that the hypertensive group had much lower regional brain volumes and worse white matter integrity- two factors associated with dementia.

In addition, negative brain changes were observed in men in some regions, including decreased gray matter volume and frontal cortex volume. The researchers believe estrogen may have protective benefits before menopause.

Finding modifiable risk factors is important as treatment for dementia is so limited, notes first author Kristen M. George, an assistant professor in the Department of Public Health Sciences.

"High blood pressure is an incredibly common and treatable risk factor associated with dementia. This study indicates hypertension status in early adulthood is important for brain health decades later," George said.

High blood pressure is common in the U.S.

High blood pressure (AKA hypertension) is blood pressure that’s higher than normal. The CDC estimates that 47% of adults have high blood pressure. Normal blood pressure is 130/80 mmHg.

Sex and race impact the rate of high blood pressure. Roughly 50% of men have high blood pressure while the rate in women is 44%. African American adults have a hypertension rate of 56% compared to 48% in white adults, 46% in Asian adults, and 39% in Hispanic adults. African American adults aged 35 to 64 are 50% more likely to have hypertension than whites.

Research from healthy aging studies

Data from 427 participants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the Study of Healthy Aging in African Americans (STAR) were reviewed. This gave the researchers health information from 1964 to 1985 for a diverse cohort of older Asian, Black, Latino, and white adults.

Two blood pressure readings were taken when the subjects were between 30 to 40 years old. This determined if subjects were normal or hypertensive into young adulthood.

MRI scans done on subjects between 2017 and 2022 provided information on late-life neuroimaging biomarkers of neurodegeneration and white matter integrity.

A large reduction in cerebral gray matter volume is observed in both men and women with hypertension but is more prevalent in men.

Brain scans show differences

The brain scans of individuals trending towards hypertension or having hypertension showed lower cerebral gray matter volume, frontal cortex volume, and fractional anisotropy (a measure of brain connectivity) compared to those with normal blood pressure. The scores for men with hypertension were lower than those for women.

This research supports previous evidence that cardiovascular risk factors at a young age may harm late-life brain health.

Due to the small sample size, the researchers note they were unable to evaluate racial and ethnic differences and advise cautiously interpreting the results between the sexes.

MRI data were also only available at one point late in life. Specific proof of neurodegeneration over time could not be predicted, only volumetric differences could be seen.

Rachel Whitmer, senior author of the study, associate director of the UC Davis Alzheimer's Disease Center, professor in the departments of Public Health Sciences and Neurology, and chief of the Division of Epidemiology exclaims, "This study truly demonstrates the importance of early life risk factors, and that to age well, you need to take care of yourself throughout life -- heart health is brain health,"

Ten Tips to Drop Your Blood Pressure

·         Follow a heart-healthy, DASH diet. Limit high-sodium, high-fat foods including fast food, fried food, processed meats, ultra-processed snacks, and full-fat dairy products.

·         Lose weight if overweight or obese. A reduction of 2.2 pounds can drop blood pressure by 1 millimeter of mercury (mm Hg).

·         Eat 4 to 5 servings of high-potassium fruits including apricots, bananas, dates, citrus fruit, peaches, mango, melon, kiwi, and dried fruit.

·         Include 4 to 5 servings of dark leafy or other vegetables in your diet daily- broccoli, collard and mustard greens, kale, peas, spinach, and more.

·         Add low-fat dairy or non-dairy products containing calcium to your diet. Low-fat yogurt, skim or 1% milk, low-fat cheese, or calcium-fortified soy milk are good choices.

·         Snack on unsalted or lightly salted almonds, pistachios, and walnuts.

·         Be moderate about alcohol and caffeine intake.

·         Walk or do another aerobic exercise for a minimum of 30 minutes most days of the week.

·         Reduce stress- meditate, do yoga or see a mental health professional if needed.

·         Heed your doctor’s advice. If your blood pressure doesn’t decline with diet and lifestyle, medication may be necessary.

Lisa Andrews, MEd, RD, LD

Reference:

1.    Kristen M. George, Pauline Maillard, Paola Gilsanz, Evan Fletcher, Rachel L. Peterson, Joseph Fong, Elizabeth Rose Mayeda, Dan M. Mungas, Lisa L. Barnes, M. Maria Glymour, Charles DeCarli, Rachel A. Whitmer. Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers. JAMA Network Open, 2023; 6 (4): e236431 DOI: 10.1001/jamanetworkopen.2023.6431