Author response: Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology

We appreciate the interest in our study on late-life blood pressure (BP) and postmortem neuropathology in nearly 1,300 community-dwelling, autopsied persons.¹ While we chose to separately examine longitudinal systolic BP (SBP) and diastolic BP (DBP) data, and indeed found more robust associations of a higher mean and more rapidly declining SBP with neuropathology, we agree that examining other BP variables provides additional insight into this area of research. Using the same datasets and a similar analytic approach of adjusted ordinal regression analyses, we found consistent results using additional BP variables. Increased variability in SBP over the years (p = 0.002), but not variability in DBP (p = 0.945), was associated with increased odds of brain infarcts, and increased mean pulse pressure over the years increased the odds of infarcts by 24% (p < 0.001). In adjusted linear regression analyses, there was no relation of variability in SBP or DBP with neurofibrillary tangles (both p > 0.574), and there was a borderline association of increased mean pulse pressure with a higher number of tangles (p = 0.084). Ongoing research will further elucidate the complex relationship of cardiovascular disease with brain dysfunction,^2,3 including whether specific neuropathologies mediate the relation of BP to dementia in aging.

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