Age of Hypertension Onset: Potential for Improving Risk Estimation and Hypertension Management?
2021; Lippincott Williams & Wilkins; Volume: 78; Issue: 5 Linguagem: Inglês
10.1161/hypertensionaha.121.18197
ISSN1524-4563
Autores Tópico(s)Health, Environment, Cognitive Aging
ResumoHomeHypertensionVol. 78, No. 5Age of Hypertension Onset: Potential for Improving Risk Estimation and Hypertension Management? Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessEditorialPDF/EPUBAge of Hypertension Onset: Potential for Improving Risk Estimation and Hypertension Management? Karri Suvila and Teemu J. Niiranen Karri SuvilaKarri Suvila https://orcid.org/0000-0002-3543-9350 Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N). and Teemu J. NiiranenTeemu J. Niiranen Correspondence to: Teemu J. Niiranen, Department of Medicine, University of Turku, Kiinamyllynkatu 4–8, 20014 University of Turku, Finland. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7394-7487 Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N). Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.). Originally published13 Oct 2021https://doi.org/10.1161/HYPERTENSIONAHA.121.18197Hypertension. 2021;78:1475–1477This article is a commentary on the followingThe Association of Age at Diagnosis of Hypertension With Brain Structure and Incident Dementia in the UK BiobankSee related article, pp 1463–1474Hypertension is a known risk factor for cardiovascular disease both among the old and young. However, more recent data have now elucidated that hypertension that manifests earlier in life confers a substantially greater risk of cardiovascular death and organ damage than high blood pressure presenting later in life.1,2 Until now, relatively few studies have assessed how the age when hypertension was initially diagnosed impacts the relationship between high blood pressure and cognitive function. In this issue of Hypertension, Shang et al3 examine the association of age at hypertension diagnosis with brain structure and dementia using a considerably larger study sample than previous studies.4–6Shang et al3 used data from the large, well-established prospective UK Biobank cohort study.7 In their study, individuals aged 40 to 69 years were recruited from 2006 to 2010, and follow-up data on brain volumes and dementia were collected from the participants using questionnaires, follow-up assessments, and health record registries. The authors implemented a case-control study design (hypertension versus no hypertension at baseline) using propensity score matching to examine if age at hypertension diagnosis was related to smaller brain volumes detected via magnetic resonance imaging or risk of incident dementia. The final study samples included 22 798 participants for the brain magnetic resonance imaging analysis and 248 106 participants for the dementia analysis. In a multivariable model, self-reported hypertension diagnosis age of <35, 35 to 44, and 45 to 54 years was associated with smaller total brain volume compared to those without hypertension. Individuals with age at hypertension diagnosis <35 years also had both smaller white and gray matter volume, whereas those diagnosed at age 35 to 44, 45 to 54, and 55 to 64 years had only smaller gray matter volume. Hypertension diagnosed ≥65 years of age was not related to any measured brain volumes. Compared with those without hypertension, individuals with hypertension diagnosis at 35 to 44, 45 to 54, and 55 to 64 years of age had increased multivariable-adjusted hazard ratios of 1.61 (95% CI, 1.31–1.99), 1.19 (95% CI, 1.06–1.33), and 1.17 (95% CI, 1.08–1.27) for all-cause dementia, respectively. Moreover, hypertension was only associated with vascular dementia in the aforementioned subgroups, but not with Alzheimer disease. Hypertension diagnosed at age <35 or ≥65 years was not related to dementia risk.The study by Shang et al3 has notable strengths, such as using open access data from a large prospective cohort study with several cognition-related outcomes. However, some limitations also merit consideration. Most importantly, baseline blood pressure level or use of antihypertensive medication was not considered in the multivariable analyses. Yet, subgroup analyses were performed based on normal or high blood pressure at baseline (dementia cohort) or concurrently with outcome measurement (brain magnetic resonance imaging cohort). This raises questions on whether consideration of current blood pressure consistently as a covariate at the time of outcome assessment could have influenced the results. Similarly, use of antihypertensive medication throughout the study might have impacted the results since they may prevent development of dementia.8 In addition, a cross-sectional analysis was used to assess the relation between age at hypertension diagnosis and brain volumes without adjusting for baseline brain magnetic resonance imaging data. Furthermore, hypertension diagnosed at <35 years of age was not associated with dementia risk, which could also result from a lack of statistical power due to the low number of events in this group. However, hypertension diagnosed at ≥65 years of age was the sole onset category that was neither related to smaller brain volumes or dementia. Moreover, given UK Biobank's low participation rate (5.5%),7 the findings by Shang et a1 may not be generalizable to the population at large due to potential selection bias. Although hypertension was also assessed from documented diagnostic codes, age at hypertension diagnosis was only defined by self-report, which might be subject to recall bias although this may be a valid method for assessing hypertension onset age.5 However, given that hypertension is mostly asymptomatic, differentiating between the age of hypertension onset and age at diagnosis is challenging as the diagnosis is often delayed in clinical practice.Compared to prior studies in this domain,4–6 the article by Shang et al3 provides new insight on the relation between age of hypertension onset and cognitive function. On the whole, early-onset hypertension is clearly linked to higher risk of vascular dementia in younger individuals (age 80 years was noted to be associated with lower risk of dementia.5 However, this finding could easily be explained by reverse causality—decreasing blood pressure at very late life could be a consequence of the neurogenerative process or imminent death.All in all, accumulating evidence supports assessment of hypertension onset age in hypertensive patients because early-onset hypertension is related to greatly increased risk of hypertensive organ damage, cognitive decline, and cardiovascular death.1–4,6 Early-onset hypertension is also more genetically driven than high blood pressure that presents in later life. Compared with having a 20 to 80 percentile range polygenic risk score for hypertension, a risk score in the highest 2.5% confers a 2.8-fold risk of early-onset hypertension (onset age <55 years) but only a 1.6-fold risk for late-onset hypertension (onset age ≥55 years).9 Despite being high-risk individuals, several studies have reported that young patients with early-onset hypertension are paradoxically less likely than older individuals to receive aggressive blood pressure management in practice.10 Future guidelines should therefore underscore the need for appropriate care in these individuals. As observational studies have now demonstrated the increased risks related to early-onset hypertension, additional research is needed to evaluate the extent to which specific interventions may be warranted for preventing or managing early-onset versus late-onset hypertension.Download figureDownload PowerPointFigure. Compared with late-onset hypertension, early-onset hypertension is more genetically driven and more strongly associated with cognitive decline and dementia.Sources of FundingT.J. Niiranen is supported by grants from the Finnish Foundation for Cardiovascular Research, the Emil Aaltonen Foundation, and the Academy of Finland (grant no. 321351).Disclosures T.J. Niiranen has received honoraria from Servier. The other author reports no conflicts.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1477.Correspondence to: Teemu J. Niiranen, Department of Medicine, University of Turku, Kiinamyllynkatu 4–8, 20014 University of Turku, Finland. Email [email protected]fiReferences1. Suvila K, McCabe EL, Lehtonen A, Ebinger JE, Lima JAC, Cheng S, Niiranen TJ. Early Onset Hypertension Is Associated With Hypertensive End-Organ Damage Already by MidLife.Hypertension. 2019; 74:305–312. doi:10.1161/HYPERTENSIONAHA.119.13069LinkGoogle Scholar2. Niiranen TJ, McCabe EL, Larson MG, Henglin M, Lakdawala NK, Vasan RS, Cheng S. Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study.BMJ. 2017; 357:j1949. doi: 10.1136/bmj.j1949CrossrefMedlineGoogle Scholar3. Shang X, Hill E, Zhu Z, Liu J, Ge Z, Wang W, He M. The association of age at diagnosis of hypertension with brain structure and incident dementia in the UK Biobank.Hypertension. 2021; 78:1463–1474. doi: 10.1161/HYPERTENSIONAHA.121.17608LinkGoogle Scholar4. Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Mungas DM, DeCarli C, Dean A, Whitmer RA. Female sex, early-onset hypertension, and risk of dementia.Neurology. 2017; 89:1886–1893. doi: 10.1212/WNL.0000000000004602CrossrefMedlineGoogle Scholar5. Corrada MM, Hayden KM, Paganini-Hill A, Bullain SS, DeMoss J, Aguirre C, Brookmeyer R, Kawas CH. Age of onset of hypertension and risk of dementia in the oldest-old: the 90+ study.Alzheimer's Dement. 2017; 13:103–110. doi: 10.1016/j.jalz.2016.09.007CrossrefMedlineGoogle Scholar6. Suvila K, Lima JAC, Yano Y, Tan ZS, Cheng S, Niiranen TJ. Early-but not late-onset hypertension is related to midlife cognitive function.Hypertension. 2021; 77:972–979. doi: 10.1161/HYPERTENSIONAHA.120.16556LinkGoogle Scholar7. Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, Downey P, Elliott P, Green J, Landray M, et al.. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.PLoS Med. 2015; 12:e1001779. doi: 10.1371/journal.pmed.1001779CrossrefMedlineGoogle Scholar8. Ding J, Davis-Plourde KL, Sedaghat S, Tully PJ, Wang W, Phillips C, Pase MP, Himali JJ, Gwen Windham B, Griswold M, et al.. Antihypertensive medications and risk for incident dementia and Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies.Lancet Neurol. 2019; 4422:1–10. doi: 10.1016/S1474-4422(19)30393-XGoogle Scholar9. Vaura F, Kauko A, Suvila K, Havulinna AS, Mars N, Salomaa V, FinnGen, Cheng S, Niiranen T. Polygenic risk scores predict hypertension onset and cardiovascular risk.Hypertension. 2021; 77:1119–1127. doi: 10.1161/HYPERTENSIONAHA.120.16471LinkGoogle Scholar10. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, et al.; PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.JAMA. 2013; 310:959–968. doi: 10.1001/jama.2013.184182CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesThe Association of Age at Diagnosis of Hypertension With Brain Structure and Incident Dementia in the UK BiobankXianwen Shang, et al. Hypertension. 2021;78:1463-1474 November 2021Vol 78, Issue 5Article InformationMetrics Download: 121 © 2021 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.121.18197PMID: 34644170 Originally publishedOctober 13, 2021 PDF download Advertisement SubjectsCardiovascular DiseaseHigh Blood PressureHypertension
Referência(s)