Dementia occurring over a 32-year follow-up attributable to hypertension observed at different ages: Implications for dementia prevention

Jason R. Smith, A. Richey Sharrett, James Russel Pike, Rebecca F. Gottesman, David S. Knopman, Mark W Lee, Pamela L. Lutsey, Priya Palta, B. Gwen Windham, Josef Coresh, Jennifer A. Deal

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1 Scopus citations


INTRODUCTION: The fraction of dementia attributable to hypertension might vary depending on the age of the population considered and the age through which dementia occurs. METHODS: In the Atherosclerosis Risk in Communities study, we quantified population attributable fractions (PAF) of dementia by age 80 and 90 from hypertension assessed at ages of 45–54 (n = 7572), 55–64 (n = 12,033), 65–74 (n = 6561), and 75–84 (n = 2086). RESULTS: The PAF for dementia by age 80 from all non-normal blood pressure at ages 45–54 was 15.3% (95% confidence interval [CI] = 6.9%–22.3%), 19.1% (95% CI = 9.9%–26.9%) at ages 55–64, and 19.9% (95% CI = −4.4%–38.5%) at ages 65–74. The strongest PAFs were from stage 2 hypertension (11.9%–21.3%). For dementia by age 90, PAFs from non-normal blood pressure up through age 75 were smaller (10.9%–13.8%), and non-significant by age 75–84. DISCUSSION: Interventions targeting hypertension even in early late life might reduce a sizeable proportion of dementia. Highlights: We estimated prospective population attributable risks of dementia for hypertension. 15%–20% of dementia cases by age 80 are from non-normal blood pressure (BP). Associations between hypertension and dementia persisted through age 75. Midlife to early late-life BP control might reduce a large proportion of dementia.

Original languageEnglish (US)
Pages (from-to)3435-3447
Number of pages13
JournalAlzheimer's and Dementia
Issue number8
StatePublished - Aug 2023

Bibliographical note

Funding Information:
The authors thank the staff and participants of the ARIC study for their important contributions. The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract Nos. 75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, and 75N92022D00005. The ARIC Neurocognitive Study is supported by U01HL096812, U01HL096814, U01HL096899, U01HL096902, and U01HL096917 from the NIH (NHLBI, National Institute of Neurological Disorders and Stroke [NINDS], National Institute on Aging, and National Institute on Deafness and Other Communication Disorders). Dr. Gottesman was supported by the NINDS Intramural Research Program. This work was also supported by the NIH (K01AG054693 [JAD] and K24HL159246 [PLL]).

Publisher Copyright:
© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.


  • cognitive impairment
  • cohort study
  • population attributable fraction
  • public health
  • vascular risk factor

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural


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