High Blood Pressure in Midlife Affects Men and Women’s Risk of Dementia Differently

A new study looks at how high blood pressure in men and women affect the risk of developing dementia. Tom Werner/Getty Images

Researchers have found that high blood pressure in midlife puts women at disproportionate risk of a condition…

 

A new study looks at how high blood pressure in men and women affect the risk of developing dementia. Tom Werner/Getty Images
  • Researchers have found that high blood pressure in midlife puts women at disproportionate risk of a condition called vascular dementia.
  • They say this could be due to disparities in treatment between men and women, or biological differences between the sexes.
  • Experts say blood pressure typically increases with age.

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In a new study published this month from the George Institute for Global Health, researchers have found that high blood pressure in midlife puts women at disproportionate risk of a condition called vascular dementia.

While a link between midlife cardiovascular events and dementia was similar for both men and women, the results were not the same for blood pressure.

“We conducted this study to examine whether there were any differences between women and men in the association of major cardiovascular risk factors for incident all-cause dementia,” lead author Jessica Gong, a PhD candidate at the George Institute for Global Health, told Healthline. “Before our study, it was not clear whether the risk factors for dementia affect women and men differently.”

To discover sex differences in cardiovascular risk factors for dementia, researchers analyzed data from the UK Biobank, a large-scale biomedical database that recruited 502,489 Britons ages 40 to 69, who were free from dementia at study start, between 2006 and 2010.

Blood pressure affected men and women’s dementia risk differently

The study found that current smoking status, diabetes, high levels of body fat, having had a prior stroke, and low socioeconomic status were all associated with increased risk of dementia to a similar degree in both men and women.

“We saw that most of the risk factors included in our study affected dementia risk in women and men to a similar extent,” Gong said.

However, when researchers looked at blood pressure, the association with dementia risk between the sexes was different. High blood pressure put women at significantly greater risk of vascular dementia than men.

Findings may indicate sex disparities in healthcare

Gong said they found a “U-shaped relationship” — meaning the relationship is first decreasing and then increasing, or vice versa — between blood pressure and the risk of dementia in men.

Basically, both high and low blood pressure leads to an increased risk of dementia.

But for women, the higher the blood pressure, the higher the risk of vascular dementia. This is also called a dose-response relationship.

“Whilst these findings could potentially be important, we don’t consider them surprising — sex disparities exist in health, and often to women’s disadvantage,” Gong said.

Gong gave accessibility to care as an example, and added that sticking to treatment may be lower in women than in men.

“There could also be biological differences between women and men that are causing these differences,” she said. “It would be prudent to conduct further studies to see if this finding is apparent in different populations.”

High blood pressure and dementia

According to experts, our cardiovascular health significantly affects our brain health.

“High blood pressure may lead to dementia by several mechanisms,” Joseph A. Diamond, MD, director of nuclear cardiology at Long Island Jewish Medical Center in New York, told Healthline. “One of the more common is to produce multiple small strokes over time.”

Diamond explained that these small strokes can cause a condition called multi-infarct dementia or vascular dementia.

“Over time, chronic high blood pressure causes changes in the very small blood vessels of the brain,” he said. “These changes may lead to ministrokes and dementia.”

Women disproportionately affected by cognitive decline

Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in New York, who specializes in memory disorders, said cognitive decline, especially from Alzheimer’s disease, affects more women than men.

According to Devi, author of “The Spectrum of Hope: An Optimistic and New Approach to Alzheimer’s Disease and other Dementias,” this could be because men experience more serious cardiovascular disease, causing earlier death and leaving fewer affected older men, with women making up two-thirds of people with Alzheimer’s in the United States.

She pointed out that reduced estrogen levels from menopause have been considered another risk factor for cognitive decline.

Joshua Yamamoto, MD, founder of the Foxhall Foundation, said there’s a difference between dementia and Alzheimer’s disease.

“Dementia is the loss of higher brain function, cognitive decline,” said Yamamoto, who is an invasive and preventive geriatric cardiologist. “Alzheimer’s is a specific, genetic disorder where the brain gets full of certain proteins that inhibit brain function.”

He pointed out that much, if not most, dementia has a vascular component and is not strictly Alzheimer’s, and that vascular dementia is “loss of higher brain function, cognitive decline, due to interrupted or inadequate blood flow to the brain.”

Reduce blood pressure, reduce dementia risk

According to Diamond, although there’s a genetic predisposition to developing high blood pressure, lifestyle changes may help prevent or decrease it.

Changes that Diamond recommends include:

  • Eating a balanced diet that’s high in plant-based products, like the DASH diet.
  • Don’t smoke.
  • Limit alcohol intake.
  • Keep physically active.
  • Manage stress.

“In addition to managing hypertension, other risk factors to manage including diabetes and high cholesterol,” he said.

Gong considers her findings evidence that an individualized approach to managing blood pressure is needed.

“An individualized approach to blood pressure treatment and management would entail considering an individual’s characteristics (sex and race) and other comorbidities,” Gong said.

She emphasized that clinicians should recommend “a tailored blood pressure-lowering regimen” and other treatment options depending on a person’s risk rather than blood pressure alone.

“Treating blood pressure is one of the most scalable and viable strategies globally to prevent dementia,” she said.

The bottom line

Researchers have found that high blood pressure in midlife puts women at disproportionate risk for a condition called vascular dementia.

They say this could be due to disparities in treatment between men and women, or biological differences between the sexes.

Experts say blood pressure typically increases with age, but healthy changes to lifestyle can significantly reduce the risk of high blood pressure and vascular dementia.

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