High blood pressure predicts hippocampal atrophy rate in cognitively impaired elders

INTRODUCTION: Understanding relationships among blood pressure (BP), cognition, and brain volume could inform Alzheimer's disease (AD) management. METHODS: We investigated Alzheimer's Disease Neuroimaging Initiative (ADNI) participants: 200 controls, 346 mild cognitive impairment (MCI), and 154 AD. National Alzheimer's Co‐ordinating Center (NACC) participants were separately analyzed: 1098 controls, 2297 MCI, and 4845 AD. Relationships between cognition and BP were assessed in both cohorts and BP and atrophy rates in ADNI. Multivariate mixed linear‐regression models were fitted with joint outcomes of BP (systolic, diastolic, and pulse pressure), cognition (Mini‐Mental State Examination, Logical Memory, and Digit Symbol) and atrophy rate (whole‐brain, hippocampus). RESULTS: ADNI MCI and AD patients with greater baseline systolic BP had higher hippocampal atrophy rates ([r, P value]; 0.2, 0.005 and 0.2, 0.04, respectively). NACC AD patients with lower systolic BP had lower cognitive scores (0.1, 0.0003). DISCUSSION: Higher late‐life BP may be associated with faster decline in cognitively impaired elders.