Elevated blood pressure is associated with advanced brain aging in mid-life: A 30-year follow-up of The CARDIA Study

Background: High blood pressure (BP) is a risk factor for late-life brain health; however, the association of elevated BP with brain health in mid-life is unclear. Methods: We identified 661 participants from the Coronary Artery Risk Development in Young Adults Study (age 18–30 at baseline) with 30 years of follow-up and brain magnetic resonance imaging at year 30. Cumulative exposure of BP was estimated by time-weighted averages (TWA). Ideal cardiovascular health was defined as systolic BP < 120 mm Hg, diastolic BP < 80 mm Hg. Brain age was calculated using previously validated high dimensional machine learning pattern analyses. Results: Every 5 mmHg increment in TWA systolic BP was associated with approximately 1-year greater brain age (95% confidence interval [CI]: 0.50–1.36) Participants with TWA systolic or diastolic BP over the recommended guidelines for ideal cardiovascular health, had on average 3-year greater brain age (95% CI: 1.00–4.67; 95% CI: 1.45–5.13, respectively). Conclusion: Elevated BP from early to mid adulthood, even below clinical cut-offs, is associated with advanced brain aging in mid-life.