title: Hypertension, Dietary Sodium, and Cognitive Decline: Results From the Women's Health Initiative Memory Study.
abstract: BACKGROUND
  To investigate the relationships of hypertension, antihypertensive treatment, and sodium intake on cognitive decline in older women.
  
  
  METHODS
  Prospective follow-up of 6,426 cognitively intact women aged 65-79 years enrolled in the Women's Health Initiative Memory Study (WHIMS) with a median follow-up of 9.1 years. Dietary sodium intake was determined by food frequency questionnaires. Hypertension was defined as self-report of current drug therapy for hypertension. Blood pressure (BP) control was assessed by treatment for hypertension and clinic measurement of systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg at baseline. Cognitive functioning was assessed annually by global cognitive screening, neurocognitive, and neuropsychiatric evaluations. Cognitive decline was identified by the incidence of mild cognitive impairment (MCI) or probable dementia (PD). Cox proportional hazards analyses were used to calculate hazard ratios (HRs).
  
  
  RESULTS
  Hypertension was associated with an increased risk for cognitive decline (HR 1.20; 95% confidence interval (CI) 1.04, 1.39; P = 0.02). Among women with antihypertensive medication, those with BP ≥140/90 mm Hg (uncontrolled BP) were at highest risk for developing cognitive decline (HR 1.30; 95% CI 1.05, 1.60) compared to women without treatment and BP <140/90mm Hg (controlled BP). Sodium intake >1,500 mg/day did not alter the risk for cognitive decline in hypertensive women or women with antihypertensive treatment (P for interaction = 0.96 or 0.97).
  
  
  CONCLUSIONS
  Women with antihypertensive treatment and uncontrolled BP showed highest risk estimates for developing cognitive decline compared to non-hypertensive women. Sodium intake did not modify the risk for cognitive decline in women with hypertension or receiving antihypertensive medication.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00685009 and NCT00745056.
authors.affiliation: Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Bavaria, Germany; haring_b@ukw.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haring
authors.affiliation: Women's Health Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA;
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Wu
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
authors.forename: Laura H
authors.initials: LH
authors.lastname: Coker
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA;
authors.forename: Arjun
authors.initials: A
authors.lastname: Seth
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA;
authors.forename: Linda
authors.initials: L
authors.lastname: Snetselaar
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Rossouw
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA;
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003071:Cognition; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003704:Dementia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D015994:Incidence; D008568:Memory; D011446:Prospective Studies; D012982:Sodium, Dietary / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D012982:Sodium, Dietary
keywords: antihypertensive treatment; blood pressure; cognitive decline; dietary sodium; hypertension.