Blood pressure at age 40 and key features of cerebral small vessel disease at age 70: data from the ACE 1950 Study

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BACKGROUND: The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. METHODS: We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012-2015) who had previously participated in the Age 40 Program (1990-1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130-139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016-2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70-79 mmHg), high elevated (80-89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. RESULTS: A total of 414 participants (167 [40%] women) were included. Participants were 70.2 ± 2.3 years when undergoing brain MRI. Mean Fazekas scale was 1.3 ± 0.8, and 54 (13%) had lacunes. SBP and DPB were not associated with lacunes. DPB of 80-89 mmHg (adjusted OR [95% CI], 1.91 [1.01-3.62]) and ≥ 90 mmHg (2.11 [1.06-4.19]) at age 40 were associated with WMHs. CONCLUSIONS: Elevated DBP (80-89 mmHg) and diastolic hypertension (> 90 mmHg) at age 40 were associated with WMH burden at age 70, suggesting a long-term association between midlife DBP and cerebrovascular health. TRIAL REGISTRATION: ClinicalTrials.gov. NCT01555411. 15 March 2012.

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