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Blood pressure from mid- to late life and risk of incident dementia
McGrath ER, Beiser AS, DeCarli C, Plourde KL, Vasan RS, Greenberg SM, Seshadri S.. Neurology, 2017-11-08
Topic: Risk, prevention and care in population studies
Objective To determine the association between blood pressure during midlife (40-64 years) to late life (≥65 years) and risk of incident dementia. Methods This study included 1,440 (758 women, mean age 69 ± 6 years) Framingham Offspring participants who were free of dementia and attended 5 consecutive examinations at 4-year intervals starting at midlife (1983-1987, mean age 55 years) until late life (1998-2001, mean 69 years) and subsequently were followed up for incident dementia (mean 8 years). We determined the effect of midlife hypertension (≥140/90 mm Hg), late life hypertension, lower late life blood pressure ( Results During the follow-up period, 107 participants (71 women) developed dementia. Using multivariable Cox proportional hazards models, we found that midlife systolic hypertension (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.05-2.35) and persistence of systolic hypertension into late life (HR 1.96, 95% CI 1.25-3.09) were associated with an elevated risk of incident dementia. However, in individuals with low to normal blood pressure (≤140/90 mm Hg) at midlife, a steep decline in systolic blood pressure during mid- to late life was also associated with a >2-fold increase in dementia risk (HR 2.40, 95% CI 1.39-4.15). Conclusions Elevated blood pressure during midlife, persistence of elevated blood pressure into late life, and, among nonhypertensives, a steep decline in blood pressure during mid- to late life were associated with an increased dementia risk in a community-based cohort. Our data highlight the potential sustained cognitive benefits of lower blood pressures in midlife but also suggest that declining blood pressure in older adults with prehypertension or normotension, but not in those with hypertension, may be a risk marker for dementia.
Key findings
- We determined the effect of midlife hypertension (≥140/90 mm Hg), late life hypertension, lower late life blood pressure ( Results During the follow-up period, 107 participants (71 women) developed dementia.
- Using multivariable Cox proportional hazards models, we found that midlife systolic hypertension (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.05-2.35) and persistence of systolic hypertension into late life (HR 1.96, 95% CI 1.25-3.09) were associated with an elevated risk of incident dementia.
- However, in individuals with low to normal blood pressure (≤140/90 mm Hg) at midlife, a steep decline in systolic blood pressure during mid- to late life was also associated with a >2-fold increase in dementia risk (HR 2.40, 95% CI 1.39-4.15).
- Conclusions Elevated blood pressure during midlife, persistence of elevated blood pressure into late life, and, among nonhypertensives, a steep decline in blood pressure during mid- to late life were associated with an increased dementia risk in a community-based cohort.
- Our data highlight the potential sustained cognitive benefits of lower blood pressures in midlife but also suggest that declining blood pressure in older adults with prehypertension or normotension, but not in those with hypertension, may be a risk marker for dementia.
Why it matters
In 1,440 Framingham participants, high blood pressure in midlife and its persistence into late life were linked to higher dementia risk, and a steep drop in blood pressure among those without hypertension was also linked to higher risk. This suggests that blood pressure patterns over time may matter for dementia risk, but it did not test whether treating blood pressure prevents dementia.
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Study details
- Participants1,440
- Effect sizeHR 1.96; HR 2.40
- Evidence strengthModerate
How this study scored 67/100
Published in a leading specialty journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,440 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 289 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 26.3 citations a year over 11 year(s) since 2017 |
| Impact for its field and year | 4 / 6 | Cited 10.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 24 other studies in this library |
| Still being cited | 3 / 4 | Cited 113 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Sudha S. Seshadri: h-index 148 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29117954) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 67 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
McGrath, E. R., Beiser, A. S., DeCarli, C., Plourde, K. L., Vasan, R. S., Greenberg, S. M., et al. (2017). Blood pressure from mid- to late life and risk of incident dementia. Neurology. https://doi.org/10.1212/wnl.0000000000004741
Vancouver
McGrath ER, Beiser AS, DeCarli C, Plourde KL, Vasan RS, Greenberg SM, et al. Blood pressure from mid- to late life and risk of incident dementia. Neurology. 2017. doi:10.1212/wnl.0000000000004741. PMID: 29117954.
BibTeX
@article{mcgrath2017-29117954,
author = {McGrath, E. R. and Beiser, A. S. and DeCarli, C. and Plourde, K. L. and Vasan, R. S. and Greenberg, S. M. and Seshadri, S.},
title = {{Blood pressure from mid- to late life and risk of incident dementia}},
journal = {Neurology},
year = {2017},
doi = {10.1212/wnl.0000000000004741},
pmid = {29117954},
url = {https://doi.org/10.1212/wnl.0000000000004741}
}
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