Association of hypertension according to new ACC/AHA blood pressure guidelines with incident dementia in the Atherosclerosis Risk in Communities cohort Open Access

Hodis, Jeffrey (Spring 2019)

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Associations between midlife hypertension and the development of dementia have been established. However, the impact of the new 2017 ACC/AHA hypertension guidelines on dementia risk at the population level has not been evaluated.


To assess the association of hypertension categories with the risk of incident dementia and to calculate the population attributable fraction (PAF) for dementia from hypertension categories defined by ACC/AHA guidelines, compared to the associations with hypertension defined by JNC7.


We studied dementia-free participants recruited to the Atherosclerosis Risk in Communities (ARIC) cohort in 1987-89. Hypertension was defined by 2003 JNC7 and 2017 ACC/AHA guidelines using blood pressure (BP) measured at baseline. Dementia was defined using adjudicated consensus diagnoses at visit 5 (2011-13), informant telephone interviews, and ICD-9 codes from hospitalizations and death certificates through 2013. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) by hypertension categories, adjusting for potential confounders. PAF of dementia by hypertension category was calculated using rate ratios from Poisson regression and the prevalence of the risk factor in the population.


Among 13,971 participants followed for a median of 23.0 years, 1381 cases of dementia were identified. HRs (95%CI) compared to normal BP according to ACC/AHA categories were 1.35 (1.12, 1.61) for elevated BP, 1.28 (1.07, 1.52) for hypertension stage 1 and 1.36 (1.18, 1.57) for hypertension stage 2. PAF (95%CI) of dementia from BP categories were 3% (1%, 5%), 3% (1%, 5%) and 9% (4%, 14%), respectively. PAF using JNC7 categories were similar to ACC/AHA: 6% (3%, 9%) for prehypertension, 0% (-2%, 2%) for hypertension stage 1, and 9% (5%, 13%) for hypertension stage 2.


Risk of dementia was increased across categories defined by ACC/AHA guidelines. However, the population impact on dementia incidence using ACC/AHA was similar to the impact of JNC7. This suggests that new criteria for hypertension will not increase the number of persons in whom hypertension could be labeled as a risk for dementia.

Table of Contents

Background/Objectives. 1

Methods. 3

Results. 6

Discussion. 10

Conclusions. 12

References. 14

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