Early Adulthood Hypertension Associated With Worse Brain Health Later in Life


In this video, Kristen M. George, PhD, assistant professor in the Department of Public Health at the University of California, Davis, discusses her study, which examined the potential association between hypertension and blood pressure in early adulthood with late-life brain health. She also explains how the results of the study fill a gap in our current knowledge and talks about what she plans on studying next.

Additional Resource: 

George KM, Maillard P, Gilsanz P, et al. Association of early adulthood hypertension and blood pressure change with late-life neuroimaging biomarkers. JAMA Netw Open. 2023;6(4):e236431. doi:10.1001/jamanetworkopen.2023.6431.

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Kristen M. George, PhD is an assistant professor in the Department of Public Health at the University of California, Davis


My name is Dr. Kristen George. I am an assistant professor at UC Davis in the Department of Public Health Sciences, and I study cardiovascular and dementia epidemiology.

Consultant360: What was the impetus for this study? Why now?

Kristen M. George, PhD: My background as a cardiovascular epidemiologist, I've been really interested in life course cardiovascular risk factors and disease. And as we learn more about dementia we're recognizing that a lot of the same risk factors for a heart attack are the same for dementia. And so I was really interested in better understanding kind of these known risk factors that are risk factors in midlife, so about age 45 to 65, what about the people who developed them earlier in the life course? So, in young adulthood. How does that affect their risk of different cognitive outcomes?

C360: How does this study fill a current gap in our knowledge?

Dr George: We know a lot about midlife because that's really when we start to see a lot of cardiovascular disease and some earlier dementia cases, but we really don't understand a lot about young adulthood. However, for dementia, as technology has improved over time, we're recognizing that there are these subtle changes in the brain and in cognition that we can see decades before someone's actually diagnosed. So, I think we really have to look towards hypertension and other cardiovascular risk factors before midlife. Before some of these brain changes are occurring to see how that influences people's trajectories.

C360: What are the knowledge gaps that still remain, and what kind of research can fill those gaps?

Dr George: There are a lot of gaps that still remain. We know that treating people's blood pressure is important throughout the life course, but we don't really know, are these people who developed hypertension in the young adulthood, if they were on a treatment plan and they stuck to it for decades are they better off than the people who just developed hypertension and maybe weren't getting treated for it or didn't stick to a treatment plan? So I think there's a lot of research that we can do to understand how even within these people who have these risk factors are there ways that we can change their trajectory and change their outcomes over the subsequent decades before they develop dementia?

C360: Why did you choose to study this particular age group (men and women between 30 and 40 years of age)?

Dr George: I think there's a huge focus on heart disease, especially in midlife. And people know like, "Oh, I need to exercise and eat healthy to prevent a heart attack." But they aren't really thinking about this influences their brain health as well. And so I think if we can wrap up all of these chronic conditions and, say, eating healthy and getting exercise in good sleep can help your outcomes across all these different bodily functions and health aspects, maybe that could be more convincing. And we can think about it as a more holistic effort to improve health instead of just focusing on maybe heart disease or something that is very acute and that they're more likely to see the outcome before it's too late with dementia, once you're having symptoms, it's been developing over several decades.

C360: As more studies investigate the connection between heart health and brain health, do you anticipate a strengthening connection between cardiovascular specialists/surgeons and neurologists?

Dr George: So I can't speak to surgeons since I'm just a lowly epidemiologist. But, there's definitely a connection between cardiovascular health and neurology and brain health. And I think that that's something that as we get better at imaging and doing blood-based biomarkers, we're understanding that relationship a lot better and we're also able to see how these things kind of are related. So people develop these cardiovascular disease and risk factors at this point in time and then their brain function and their cognition and brain imaging starts to change also around that same time. And so we're kind of seeing over the timeline of the life course, kind of how these things play out.

C360: What do you plan on studying next?

Dr George: We're continuing to do brain scans, and so I'm hoping that we can look at the same individual but look at multiple of their brain scans so that we can really see if there's neuro-degeneration happening. We also are really interested in sex differences because we know that men tend to have heart disease and develop risk factors a little bit earlier than women. And so understanding how sex related differences might influence outcomes.

C360: What is the overall take-home message of your study?

Dr George: I think definitely doing things to improve your heart health and prevent hypertension, like eating healthfully, exercising, getting good sleep are really important. And especially when you're younger, it's really important to start getting into those habits. And if you do develop a hypertension or any cardiovascular risk factor, making sure that you really stick to a treatment plan because a lot of these risk factors, especially hypertension, are very treatable. And so making sure that you stay on a treatment plan and follow your doctor's recommendations.