High blood pressure in young people may have a negative effect on their brains in midlife, research suggests, raising concerns that the stresses and sedentary lifestyles many have experienced during the pandemic could have a lifelong cognitive impact.
The findings of this small study of 142 participants support those of other studies. A 2020 review that examined the effects of hypertension on the brain at all ages found that heightened blood pressure in early life, even in childhood, relates to altered brain structure, cerebrovascular function and cognitive processing. It also found that available evidence is insufficient to explain the pattern of brain deficits related to high blood pressure, but that early intervention may reduce blood pressure and help maintain brain function.
“Brain injury is cumulative, and it starts sooner than we think,” says Mitch Elkind, professor of neurology and epidemiology at Columbia University Irving Medical Center and chief of the Division of Neurology Clinical Outcomes Research and Population Sciences. “The earlier in life we look, the more evidence we find that early life changes in cardiovascular risk factors, such as blood pressure, are associated with later-life evidence of brain injury, including undetected strokes, damage to the brain’s white matter, and cognitive impairment.”
Cause for concern
These findings are cause for concern because pediatric hypertension in the United States has increased fourfold over the last 30 to 40 years, according to Johns Hopkins Medicine. About 1 in 25 youth, ages 12 to 19, have high blood pressure (hypertension), and 1 in 10 have elevated blood pressure, according to data from the Centers for Disease Control and Prevention.
Alan Sved, professor of neuroscience at the University of Pittsburgh, who co-wrote the 2020 review, says of the February study that it “further stresses the importance of this problem. Monitoring blood pressure at young ages and paying attention to elevated blood pressure in childhood, even blood pressures that would be considered at the slightly elevated or ‘prehypertensive stage,’ can help reduce long-term problems.”
The February study suggests that high blood pressure starting at a young age was associated with a smaller brain at midlife (around age 50). Christina Lineback, lead author of the study and a vascular neurology fellow at Northwestern Memorial Hospital in Chicago, says, “The brain areas we measured are important structures, such as the hippocampus, which is responsible for memory formation.”
She describes how walking, cognition and even emotions can be affected by these brain changes. “This suggests that if we better controlled blood pressure in young people there may be less brain changes over time,” she says.
Sved agrees and says, “While high blood pressure in young people can negatively impact their brain health later in life, there is every reason to believe that interventions aimed at reducing their blood pressure and other cardiovascular disease risk factors can improve that situation.”
Diagnosis and treatment
A sedentary lifestyle and stress can contribute to high blood pressure in young people, but so can other factors such as sleep apnea, kidney disease, thyroid problems and certain medications. Blood tests, urinalysis, echocardiograms, renal ultrasounds and other methods can detect these conditions. Some people may not know that they have high blood pressure, so screening remains important.
When a child’s blood pressure is higher than normal during at least three visits to their doctor, they are diagnosed with high blood pressure, according to the Mayo Clinic. After a diagnosis, determining the type of high blood pressure — primary or secondary — is critical. Primary high blood pressure has environmental or genetic causes. Secondary high blood pressure is the result of another medical condition.
High blood pressure in young people is typically treated first with lifestyle changes, including a heart-healthy diet, regular exercise and maintaining a healthy weight. When lifestyle changes aren’t enough, a doctor may recommend medication. These medications can include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers and diuretics.
“Many things can contribute to high blood pressure that we can work on, including having an active lifestyle, healthy diet and avoiding smoking,” Lineback says. “The American Heart Association’s ‘Simple Seven’ is a great reference to improve your cardiovascular and brain health.”
Sved agrees: “The impact of a healthy lifestyle, including diet and exercise, cannot be overstated.”