title: Lifetime hypertension as a predictor of brain structure in older adults: cohort study with a 28-year follow-up.
abstract: BACKGROUND
  Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure.
  
  
  OBJECTIVE
  To examine lifetime blood pressure as a predictor of brain structure in old age.
  
  
  METHODS
  A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities.
  
  
  RESULTS
  Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy.
  
  
  CONCLUSIONS
  Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose-response pattern.
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Allan
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Enikõ
authors.initials: E
authors.lastname: Zsoldos
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Filippini
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Sexton
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Anya
authors.initials: A
authors.lastname: Topiwala
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Vyara
authors.initials: V
authors.lastname: Valkanova
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tabák
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Mackay
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Klaus P
authors.initials: KP
authors.lastname: Ebmeier
authors.affiliation: Charlotte L. Allan, MRCPsych, MD(Res), Enikõ Zsoldos, MSc, Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Anya Topiwala, MRCPsych, Vyara Valkanova, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, University College London, London, UK and INSERM U1018, Hôpital Paul Brousse, France; Adam G. Tabák, MD, PhD, Department of Epidemiology and Public Health, University College London, London, UK and 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary; Martin J. Shipley, MSc, Department of Epidemiology and Public Health, University College London, London, UK; Clare Mackay, PhD, Klaus P. Ebmeier, FRCPsych, MD, Neurobiology of Ageing Group, Department of Psychiatry, University of Oxford, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001794:Blood Pressure; D001921:Brain / Q000000981:diagnostic imaging*; D003072:Cognition Disorders / Q000150:complications; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications; D003866:Depressive Disorder / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012307:Risk Factors; D017678:Sex Distribution