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Hypertension is associated with better brain health outcomes in older-age asymptomatic carotid disease populations - A Multi-Cohort Study
Weinkauf C, Zahra S, Hong A, Arias J, French S, Wiskoski H, Luu I, Oxnam E et al.. Research Square, 2026-09-10
Topic: Brain imaging, connectivity and assessment
Plain-language summary
Background: Blood pressure (BP) management is highly relevant for cardiovascular and brain health outcomes. Although clinical guidelines are trending towards increasingly strict BP control, some discordant results evaluating dementia-related outcomes indicate that more research is needed. Asymptomatic extracranial carotid atherosclerotic disease (aECAD), a hallmark cerebrovascular disease affecting > 10% of those over the age of 60, may represent a key subpopulation unaccounted for in previous studies. Methods: Using our Carotids and Minds prospective study and TriNetX, a US nationwide medical record database, we evaluated the association of hypertension status with dementia-related outcomes in adults ≥ 50 years of age with and without aECAD. We investigated secondary effects of age, systolic BP (SBP) ranges, hypertension medications, cardiovascular outcomes, and treatment of aECAD with carotid endarterectomy (CEA). Results After controlling for relevant confounders, hypertension was significantly associated with higher cognitive scores (β = 0.47, p< .01), lower pTau217 (β= -0.52, p<.01) and lower AD (HR = 0.56 [0.52–0.61]), non-AD dementia (HR = 0.66 [0.63–0.68]), and MCI risk (HR = 0.69 [0.64–0.74]) in patients with aECAD. Effect sizes were moderate to large and congruous across both cohorts, with strongest risk reduction in aECAD patients 81 + years of age. CEA mitigated these protective associations, and significantly higher risk of ADRD was seen in hypertensives without aECAD. Still more, a SBP range of 140–159 mmHg optimized protective effects with no significant increase in major cardiovascular events and death. Conclusion In summary, hypertension is associated with lower risk of dementia-related outcomes in aECAD patients. This promotes the need for future clinical trials focusing on individualized BP goals and addressing cerebrovascular disease. More broadly, these data further highlight cerebrovascular disease as relevant in brain health and aging.
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APA 7th
Weinkauf, C., Zahra, S., Hong, A., Arias, J., French, S., Wiskoski, H., et al. (2026). Hypertension is associated with better brain health outcomes in older-age asymptomatic carotid disease populations - A Multi-Cohort Study. Research Square. https://doi.org/10.21203/rs.3.rs-10731777/v1
Vancouver
Weinkauf C, Zahra S, Hong A, Arias J, French S, Wiskoski H, et al. Hypertension is associated with better brain health outcomes in older-age asymptomatic carotid disease populations - A Multi-Cohort Study. Research Square. 2026. doi:10.21203/rs.3.rs-10731777/v1.
BibTeX
@article{weinkauf2026-21596d92,
author = {Weinkauf, C. and Zahra, S. and Hong, A. and Arias, J. and French, S. and Wiskoski, H. and Luu, I. and Oxnam, E. and others},
title = {{Hypertension is associated with better brain health outcomes in older-age asymptomatic carotid disease populations - A Multi-Cohort Study}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10731777/v1},
url = {https://doi.org/10.21203/rs.3.rs-10731777/v1}
}
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Key findings
- Although clinical guidelines are trending towards increasingly strict BP control, some discordant results evaluating dementia-related outcomes indicate that more research is needed.
- Results After controlling for relevant confounders, hypertension was significantly associated with higher cognitive scores (β = 0.47, p< .01), lower pTau217 (β= -0.52, p<.01) and lower AD (HR = 0.56 [0.52–0.61]), non-AD dementia (HR = 0.66 [0.63–0.68]), and MCI risk (HR = 0.69 [0.64–0.74]) in patients with aECAD.
- CEA mitigated these protective associations, and significantly higher risk of ADRD was seen in hypertensives without aECAD.
- Still more, a SBP range of 140–159 mmHg optimized protective effects with no significant increase in major cardiovascular events and death.
- Conclusion In summary, hypertension is associated with lower risk of dementia-related outcomes in aECAD patients.
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Study details
- Effect sizeHR = 0.56; HR = 0.66; HR = 0.69
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 26 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, studied in people and randomized / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 16 of the 62 points we could judge it on, which is 26 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 16 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 16 of the 62 points we could judge it on is 26 out of 100. |
| Total | 26 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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