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.