Research Summary

Is There an Association Between Early Adulthood Hypertension And Worse Brain Health Later in Life?

Anthony Calabro, MA

In a recent cohort study, researchers found that early adulthood hypertension and increased blood pressure (BP) were associated with negative brain changes later in life, including lower regional brain volumes and worse white matter integrityfactors that are associated with dementia.1 The researchers also found that the association was greater in men than in women.

Previous studies2,3 have shown that mid-life hypertension is associated with late-life cognitive decline and dementia. And although hypertension prevalence is initially higher in men compared with women, after age 65, the higher prevalence switches from men to women.

Neuroimaging studies have also pointed to an association between mid-life hypertension and Alzheimer disease and related dementia (ADRD),4 neurodegeneration,5 and white matter hyperintensities (WMHs).6 Importantly, large volumes of WMHs are associated with Alzheimer disease and cognitive decline.

These negative brain changes generally begin years before dementia onset, which suggests that hypertension prevention measures to reduce the chance of ADRD later in life should begin earlier, perhaps during early adulthood (considered between 30 and 40 years of age).

Enter Kristen M. George, PhD, and colleagues, who reported on the association and the potential sex differences between hypertension and blood pressure in early adulthood with late-life brain health.

“As technology has improved over time, we're recognizing that there are these subtle changes in the brain and in cognition that we can see decades before someone's actually diagnosed,” Dr George, assistant professor in the Department of Public Health at the University of California, Davis and lead author of the current study, told Consultant360. “So, I think we really have to look towards hypertension and other cardiovascular risk factors before mid-life. Before some of these brain changes are occurring to see how that influences people's trajectories.”

The researchers gathered data from two studies: the Study of Healthy Aging in African Americans (STAR) and the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study. Both studies include longitudinal cohorts of racially diverse adults aged 50 years and older from Northern California.

In their study, Dr George and colleagues included 427 participants from the KHANDLE and STAR studies who received health assessments between June 1, 1964, and March 31, 1985. Researchers measured the regional brain volumes and white matter integrity using magnetic resonance imaging (MRI) between June 1, 2017, and March 1, 2022.

Among the 427 participants, the median age of participants was: 28.9 years at the first assessment, 40.3 years at the last assessment, and 74.8 years at time of the MRI scans. The participants were diverse: 61.6% were women and 54.1% were Black. Overall, 191 participants (44.7%) had normotension, 68 (15.9%) transitioned to hypertension, and 168 (39.3%) had hypertension.

Compared with participants who did not have hypertension, those who had hypertension and those who transitioned to hypertension had smaller brain volumes, which suggests a loss of brain cells, and worse white matter integrity, which hinders the communication between brain regions.7 The results also showed that these brain changes, which are associated with dementia, were more prominent in men.

Additionally, Dr George and colleagues assessed participants’ BP change by separately examining their systolic and diastolic BP. The researchers found that a 5 mm Hg increase in systolic BP between the first and last checkup was associated with lower temporal cortex volume, a potential sign of cognitive decline or dementia. This association was found to be significantly stronger in men than women, as well.

“The findings of this cohort study involving diverse older adults suggested that early adulthood hypertension and BP change were associated with differences in late-life neuroimaging biomarkers that are implicated in cognitive decline and dementia,” the researchers concluded. “This work emphasizes the need to better understand how sex and timing of the onset of hypertension and BP change modify the association between hypertension and neurodegeneration.”

Want more expert perspective? Watch our video interview with Kristen M. George, PhD, lead author of the study, “Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers.”


1.     George KM, Maillard P, Gilsanz P, et al. Association of early adulthood hypertension and blood pressure change with late-life neuroimaging biomarkers. JAMA Netw Open. 2023;6(4):e236431. doi:10.1001/jamanetworkopen.2023.6431.

2.     Yaffe K, Bahorik AL, Hoang TD, et al.  Cardiovascular risk factors and accelerated cognitive decline in midlife: the CARDIA study. Neurology. 2020;95(7):e839-e846. doi:10.1212/WNL.0000000000010078.

3.     Gottesman RF, Schneider ALC, Albert M, et al. Midlife hypertension and 20-year cognitive change: the Atherosclerosis Risk in Communities Neurocognitive Study. JAMA Neurol. 2014;71(10):1218-1227. doi:10.1001/jamaneurol.2014.1646

4.     Lamar M, Boots EA, Arfanakis K, Barnes LL, Schneider JA. Common brain structural alterations associated with cardiovascular disease risk factors and Alzheimer’s dementia: future directions and implications. Neuropsychol Rev. 2020;30(4):546-557. doi:10.1007/s11065-020-09460-6

5.     Daugherty AM. Hypertension-related risk for dementia: a summary review with future directions. Semin Cell Dev Biol. 2021;116:82-89. doi:10.1016/j.semcdb.2021.03.002

6.     Wartolowska KA, Webb AJS. Midlife blood pressure is associated with the severity of white matter hyperintensities: analysis of the UK Biobank cohort study. Eur Heart J. 2021;42(7):750-757. doi:10.1093/eurheartj/ehaa756.

7.     White matter disease. Cleveland Clinic. Updated May 4, 2022. Accessed April 18, 2023.,the%20tissue%20its%20white%20color.