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For Your Patients-Alzheimer's Pathology

An analysis of blood pressure data from nearly 1,300 persons in late life found that both higher and declining systolic blood pressure increased the odds of having one or more brain infarcts. In addition, higher mean systolic blood pressure over time was associated with a higher number of Alzheimer’s disease tangles in the brain, according to the paper published online July 11 in Neurology. “While the relationship between high blood pressure and brain infarcts was expected based on previous research including a seminal study published in the July/August 1976 issue of Stroke, we were surprised that a faster decline in systolic blood pressure in late life also increased the odds of having one or more infarcts,” lead investigator Zoe Arvanitakis, MD, MS, FAAN, medical director of Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago, told Neurology Today. “The takeaway is that you can’t ignore blood pressure even later in life because both increasing and decreasing levels appear to be unhealthy for the brain,” said Dr. Arvanitakis. Previous clinical and neuroimaging research, including a study published in the December 2012 Lancet Neurology, established that hypertension is a risk factor for stroke, but most of the studies involved subjects in mid-life. “Few studies have looked at people in late life to investigate the relationship between a range of blood pressure values and brain pathology,” said Dr. Arvanitakis. Although neuroimaging testing is now more sophisticated than ever, only postmortem assessments can definitively detect microscopic cerebrovascular disease such as infarcts and Alzheimer’s pathologies including amyloid plaques and neurofibrillary tangles. “This study extends the knowledge from beyond what’s available in the literature currently,” said Dr. Arvanitakis.