Abstract Details

Title Sex Differences in the Association of Blood Pressure Decline with Postmortem Brain Vessel Pathology

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-020

Objective To examine for sex differences in the associations between late-life blood pressure (BP) change with postmortem brain vessel pathology among older adults followed longitudinally.

Background Hypertension contributes to arteriolosclerosis and atherosclerosis, both of which increase stroke and dementia risk. While hypertension is more common during aging, declining BP has been reported in the very old and is associated with mortality. Our prior study of >4700 older adults found that simultaneous declines in systolic BP (SBP) and cognition occurred primarily in older women but not men, suggesting declining BP may disproportionately impact women in brain aging.

Design/Methods We analyzed data from 1820 community-dwelling older adults without baseline dementia (mean baseline age=80.2 [SD=6.9] years; 69% women) from four longitudinal cohort studies who underwent autopsy (mean age-at-death=90.3 [6.4] years). Annual clinical evaluations, over an average of 9.1 [5.7] years, included assessment of BP and direct medication inspection. Neuropathological examinations documented the presence of arteriolosclerosis and severity of atherosclerosis. Person-specific BP slopes from annual measures were used in logistic (presence) and ordinal (severity) regressions adjusted for age-at-death, sex, baseline BP, and antihypertensives.

Results For arteriolosclerosis, in women each unit of decline in SBP slope was associated with 31% higher odds of arteriolosclerosis (OR=1.31, 95%CI=1.05–1.63, p=0.02), whereas no significant association was observed in men (OR=1.08, p>0.05). A significant sex × SBP slope interaction (OR=1.41, p=0.03) indicated a stronger association in women. Decline in diastolic BP (DBP) slope was not related to arteriolosclerosis and showed no sex interaction. For atherosclerosis, greater declines in both SBP and DBP were associated with higher severity of atherosclerosis (SBP OR=2.13, 95%CI=1.77–2.58, p<0.01; DBP OR=1.29, 95%CI=1.06–1.56, p=0.01), with no evidence of sex differences.

Conclusions This longitudinal, clinical-pathologic study of >1800 older deceased persons showed sex differences in the association between declining SBP with arteriolosclerosis. Future research will need to replicate and expand on these results.

Authors/Disclosures
Nicholas W. Baumgartner, PhD PRESENTER	Dr. Baumgartner has nothing to disclose.
Rupal Mehta (Rush University)	Rupal Mehta has nothing to disclose.
Lianlian Du, PhD	Dr. Du has nothing to disclose.
Zoe Arvanitakis, MD, MS, FAAN (Rush Alzheimer's Disease Center)	Dr. Arvanitakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Inc.. Dr. Arvanitakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Arvanitakis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Dementia. Dr. Arvanitakis has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for a private legal firm representing a governemental entity. The institution of Dr. Arvanitakis has received research support from National Institutes of Health (NIH). Dr. Arvanitakis has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with The National Institutes of Health and California State (California Institute for Regenerative Medicine or CIRM). Dr. Arvanitakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant and Educator with Summus Global, Inc.

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