Cumulative BP levels linked to racial disparities in cognitive decline
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Possibly because of higher cumulative BP levels, black individuals with had faster declines in global cognition compared with white individuals, according to a study published in JAMA Neurology.
“Older African Americans are twice as likely as older whites to develop dementia,” Deborah A. Levine, MD, MPH, associate professor of medicine and director of the Cognitive Health Services Research Program at University of Michigan in Ann Arbor, told Healio. “It is important to understand the reasons for these racial disparities in dementia so that we can reduce them and prevent dementia.”
Patients free from stroke, dementia
Researchers analyzed data from 19,378 people (mean age at first cognitive assessment, 60 years; 55% women; 80% white) who self-reported as white or black and were free from stroke and dementia at baseline. Longitudinal cognitive, BP and covariate data were obtained from five cohorts from 1971 to 2017: CARDIA study, ARIC study, Framingham Offspring Study, Cardiovascular Health Study and Northern Manhattan Study.
The primary outcome was change in global cognition. Researchers also assessed secondary outcomes including change in memory and executive function. Follow-up was conducted for a median of 12.4 years.
Black participants had significantly faster declines in memory (0.08 points per year faster; 95% CI, 0.11 to 0.06) and global cognition (0.03 points per year faster; 95% CI, 0.05 to 0.01) compared with white participants. Black individuals also had significantly slower declines in executive function (0.09 points per year slower; 95% CI, 0.08-0.1).
Time-dependent cumulative mean systolic BP was linked to significantly faster declines in memory (0.028 points per year faster per each 10 mm Hg increase; 95% CI, 0.035 to 0.021), global cognition (0.018 points per year faster per each 10 mm Hg increase; 95% CI, 0.023 to 0.014) and executive function (0.01 points per year faster per each 10 mm Hg increase; 95% CI, 0.014 to 0.007).
The differences between black and white participants in cognitive slopes were attenuated for memory (0.06 points per year; 95% CI, 0.08 to 0.03) and global cognition (0.01 points per year; 95% CI, 0.03 to 0.01) after adjusting for cumulative mean systolic BP. This did not occur for executive function (0.1 points per year; 95% CI, 0.09-0.11).
“Our study emphasizes that all adults, especially African Americans, receive standard, low-cost treatments to control high blood pressure,” Levine said in an interview. “African Americans have an earlier average age of onset, greater severity of high BP and worse control than whites.”
Future research
Levine told Healio that “We need research on effective interventions that will reduce racial disparities in cognitive decline. Our exciting findings suggest that effective interventions to improve BP control in African Americans might also be successful strategies to reduce racial disparities in cognitive declines.” – by Darlene Dobkowski
For more information:
Deborah A. Levine, MD, MPH, can be reached at deblevin@umich.edu.
Disclosures: Levine reports she received grants from the NIH. Please see the study for all other authors’ relevant financial disclosures.
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