Summary: High blood pressure in your 30s increases the risk of cognitive decline and dementia decades later. Early detection and treatment of hypertension may help reduce the likelihood of dementia and Alzheimer’s disease in later life.
Source: UC Davis
New research from UC Davis links high blood pressure in your 30s to poorer brain health at about age 75, with stronger effects observed in men.
Published in JAMA Network Open, the study analyzed magnetic resonance imaging (MRI) scans of older adults who had high blood pressure between ages 30 and 40 and compared them with scans from people who had normal blood pressure in early adulthood.
Participants who had hypertension in early adulthood showed notably smaller brain region volumes and reduced white matter integrity on MRI—both established biomarkers associated with dementia risk.
Some regional changes, including reduced gray matter and smaller frontal cortex volume, were more pronounced in men. The authors suggest sex differences may relate in part to estrogen’s protective effects before menopause.
“Because effective treatments for dementia are limited, identifying modifiable risk factors across the life course is essential to reduce disease burden,” said Kristen M. George, the study’s first author and an assistant professor in the Department of Public Health Sciences at UC Davis.
“Hypertension is common and treatable. This study emphasizes that blood pressure in early adulthood can have meaningful implications for brain health decades later,” George added.
High blood pressure is common in the U.S.
Hypertension, defined as blood pressure consistently above typical healthy ranges (generally considered higher than about 130/80 mmHg), affects a large portion of U.S. adults. The Centers for Disease Control and Prevention estimates nearly half of U.S. adults have high blood pressure.
Prevalence varies by sex and race: a slightly higher percentage of men than women have hypertension, and Black adults have among the highest rates. These differences highlight the importance of targeted public health strategies and early monitoring.
Data drawn from long-term aging studies
Researchers analyzed data from 427 participants enrolled in two long-term studies: the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the Study of Healthy Aging in African Americans (STAR). These cohorts include racially and ethnically diverse older adults from the San Francisco Bay Area and Sacramento Valley.
The team used two blood pressure measurements taken when participants were roughly 30 to 40 years old to classify each person as normotensive, transitioning to hypertension, or hypertensive in early adulthood. They then examined MRI scans collected between 2017 and 2022 for signs of late-life brain changes linked to neurodegeneration and white matter deterioration.
Across both sexes, early-adulthood hypertension was associated with a significant reduction in cerebral gray matter volume, with the effect appearing stronger in men.
MRI scans show measurable differences
Compared with participants who maintained normal blood pressure in early adulthood, those who were hypertensive or who transitioned to hypertension had smaller overall cerebral volumes, reduced gray matter and frontal cortex volumes, and lower fractional anisotropy, a diffusion MRI metric that reflects white matter integrity and brain connectivity. Men with early hypertension tended to have lower scores on these measures than women.
These findings add to growing evidence that cardiovascular risk factors in young adulthood—particularly elevated blood pressure—can negatively influence brain structure and resilience in later life.
The authors caution that the sample size limited detailed analysis of racial and ethnic differences, and that MRI data were available from a single late-life time point. A single scan can reveal volumetric and structural differences but cannot by itself track the progression of neurodegeneration over time.
“This study highlights the importance of addressing risk factors early in life. To achieve healthy brain aging, attention to cardiovascular health across the life course matters—heart health is brain health,” said Rachel Whitmer, senior author and professor in the departments of Public Health Sciences and Neurology at UC Davis, who also serves as associate director of the UC Davis Alzheimer’s Disease Center.
Whitmer noted the team plans to continue following participants to better understand which early-life actions most strongly support healthier brain aging in late life.
Additional authors on the study include researchers from UC Davis, Kaiser Permanente Division of Research, University of Montana, UCLA, Rush Medical College, and UCSF.
About this dementia research news
Author: Lisa Howard
Source: UC Davis
Contact: Lisa Howard – UC Davis
Image: The image is in the public domain
Original Research: Open access.
“Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers” by Kristen M. George et al. JAMA Network Open
Abstract
Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers
Importance
The long-term impact of hypertension arising before midlife on late-life brain health is underexplored. Biological differences, including estrogen’s cardioprotective effects prior to menopause, suggest these associations may vary by sex.
Objective
To evaluate how hypertension in early adulthood and changes in blood pressure relate to late-life neuroimaging biomarkers, and to examine whether these associations differ between men and women.
Design, Setting, and Participants
This cohort study pooled data from the STAR and KHANDLE studies—longitudinal, racially and ethnically diverse cohorts of adults aged 50 and older in California. The analysis included 427 participants who had health assessments between 1964 and 1985 and underwent 3T MRI between 2017 and 2022 to measure regional brain volumes and white matter integrity.
Exposures
Researchers categorized hypertension status (normotension, transition to hypertension, hypertension) and calculated blood pressure change using two multiphasic health checkups conducted in early adulthood (ages 30–40).
Main Outcomes and Measures
Regional brain volumes and white matter integrity were z-standardized and analyzed using general linear models adjusted for demographic characteristics and study cohort. Interactions by sex were assessed.
Results
Among 427 participants, median ages were about 29 at the first checkup, 40 at the last checkup, and 75 at neuroimaging. Roughly 62% were female and more than half identified as Black. About 45% remained normotensive, 16% transitioned to hypertension, and 39% had hypertension in early adulthood.
Compared with those who remained normotensive, participants with hypertension or who transitioned to hypertension had smaller cerebral volumes, reduced gray matter, decreased frontal and parietal cortex volumes, and lower fractional anisotropy—markers linked to neurodegeneration. Hypertension was also associated with smaller hippocampal volume, larger ventricular volumes, and greater free water content. Incremental increases in systolic and diastolic blood pressure were associated with smaller temporal and parietal cortex volumes, respectively. For some regional measures, detrimental associations were stronger in men.
Conclusions and Relevance
Early adulthood hypertension and increases in blood pressure are associated with late-life brain volume reductions and white matter differences implicated in neurodegeneration and dementia. Some sex-specific differences suggest early hypertension may be particularly harmful for men. These results underscore the importance of preventing and treating hypertension early in adulthood to support brain health later in life.