title: Long-term blood pressure variability throughout young adulthood and cognitive function in midlife: the Coronary Artery Risk Development in Young Adults (CARDIA) study.
abstract: Whether long-term blood pressure (BP) variability throughout young adulthood is associated with cognitive function in midlife remains uncertain. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited healthy young adults aged 18 to 30 years (mean age, 25 years) at baseline (Y(0)), we assessed BP variability by SD and average real variability (ARV) for 25 years (8 visits). Cognitive function was assessed with the Digit Symbol Substitution Test (psychomotor speed test), the Rey Auditory Verbal Learning Test (verbal memory test), and the modified Stroop test (executive function test) at follow-up (Y(25)). At the Y(25) examination, participants (n=2326) had a mean age of 50.4 years, 43% were men, and 40% were black. In multivariable-adjusted linear regression models, higher ARV(SBP), ARV(DBP), and SD(DBP) were significantly associated with lower scores of Digit Symbol Substitution Test (β [SE]: -0.025 [0.006], -0.029 [0.007], and -0.029 [0.007], respectively; all P<0.001) and Rey Auditory Verbal Learning Test (β [SE]: -0.016 [0.006], -0.021 [0.007], and -0.019 [0.007], respectively; all P<0.05) after adjustment for demographic and clinical characteristics and with cumulative exposure to BP through Y(0) to Y(25). Neither SDBP nor ARV(BP) was associated with the Stroop score. The associations between ARV(BP) or SD(BP) and each cognitive function test were similar between blacks and whites except for 1 significant interaction between race and SDS(BP) on the Digit Symbol Substitution Test (P<0.05). Long-term BP variability for 25 years beginning in young adulthood was associated with worse psychomotor speed and verbal memory tests in midlife, independent of cumulative exposure to BP during follow-up.
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Norrina
authors.initials: N
authors.lastname: Allen
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.).
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., N.A., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD (L.J.L.); and Department of Psychiatry, University of California, San Francisco (K.Y.). dlj@northwestern.edu.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009819:Office Visits; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D055815:Young Adult
keywords: blood pressure; cognition; young adult