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Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction

Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction
Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction

Higher early-life cognitive function is associated with better later-life health outcomes, including hypertension. Associations between higher prior cognitive function and less hypertension persist even when accounting for socioeconomic status, but socioeconomic status-hypertension gradients are more pronounced in women. We predicted that differences in hypertension development between sexes might be associated with cognitive function and its interaction with sex, such that higher early-life cognitive function would be associated with lower hypertension risk more in women than in men. We used accelerated failure time modeling with the National Longitudinal Study of Youth 1979. Cognitive function was assessed in youth, when participants were aged between 14 and 21 years. Of 2572 men and 2679 women who completed all assessments, 977 men and 940 women reported hypertension diagnoses by 2015. Socioeconomic status in youth and adulthood were investigated as covariates, as were components of adult socioeconomic status: education, occupational status, and family income. An SD of higher cognitive function in youth was associated with reduced hypertension risk (acceleration factor: ĉ=0.97; 95% CI, 0.96-0.99; P=0.001). The overall effect was stronger in women (sex×cognitive function: ĉ=0.97; 95% CI, 0.94-0.99; P=0.010); especially, higher functioning women were less at risk than their male counterparts. This interaction was itself attenuated by a sex by family income interaction. People with better cognitive function in youth, especially women, are less likely to develop hypertension later in life. Income differences accounted for these associations. Possible causal explanations are discussed.

cognition, humans, hypertension, income, sex
0194-911X
812-819
Altschul, Drew M.
733a0f68-fe0b-424a-a659-0bd19bf40dff
Wraw, Christina
b9230287-fb59-4fe0-a135-de0619de45fb
Der, Geoff
f875630a-5250-491e-b44d-d89572ba6be7
Gale, Catharine R.
5bb2abb3-7b53-42d6-8aa7-817e193140c8
Deary, Ian J.
027158ae-fbfb-40ea-98b1-32d2690499ac
Altschul, Drew M.
733a0f68-fe0b-424a-a659-0bd19bf40dff
Wraw, Christina
b9230287-fb59-4fe0-a135-de0619de45fb
Der, Geoff
f875630a-5250-491e-b44d-d89572ba6be7
Gale, Catharine R.
5bb2abb3-7b53-42d6-8aa7-817e193140c8
Deary, Ian J.
027158ae-fbfb-40ea-98b1-32d2690499ac

Altschul, Drew M., Wraw, Christina, Der, Geoff, Gale, Catharine R. and Deary, Ian J. (2019) Hypertension development by midlife and the roles of premorbid cognitive function, sex, and their interaction. Hypertension, 73 (4), 812-819. (doi:10.1161/HYPERTENSIONAHA.118.12164).

Record type: Article

Abstract

Higher early-life cognitive function is associated with better later-life health outcomes, including hypertension. Associations between higher prior cognitive function and less hypertension persist even when accounting for socioeconomic status, but socioeconomic status-hypertension gradients are more pronounced in women. We predicted that differences in hypertension development between sexes might be associated with cognitive function and its interaction with sex, such that higher early-life cognitive function would be associated with lower hypertension risk more in women than in men. We used accelerated failure time modeling with the National Longitudinal Study of Youth 1979. Cognitive function was assessed in youth, when participants were aged between 14 and 21 years. Of 2572 men and 2679 women who completed all assessments, 977 men and 940 women reported hypertension diagnoses by 2015. Socioeconomic status in youth and adulthood were investigated as covariates, as were components of adult socioeconomic status: education, occupational status, and family income. An SD of higher cognitive function in youth was associated with reduced hypertension risk (acceleration factor: ĉ=0.97; 95% CI, 0.96-0.99; P=0.001). The overall effect was stronger in women (sex×cognitive function: ĉ=0.97; 95% CI, 0.94-0.99; P=0.010); especially, higher functioning women were less at risk than their male counterparts. This interaction was itself attenuated by a sex by family income interaction. People with better cognitive function in youth, especially women, are less likely to develop hypertension later in life. Income differences accounted for these associations. Possible causal explanations are discussed.

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Accepted/In Press date: 8 January 2019
e-pub ahead of print date: 19 February 2019
Keywords: cognition, humans, hypertension, income, sex

Identifiers

Local EPrints ID: 429604
URI: https://eprints.soton.ac.uk/id/eprint/429604
ISSN: 0194-911X
PURE UUID: 8190e169-7e3f-4726-b71e-f105e7410de6
ORCID for Catharine R. Gale: ORCID iD orcid.org/0000-0002-3361-8638

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Date deposited: 01 Apr 2019 16:30
Last modified: 11 Apr 2019 00:38

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