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BACKGROUND: Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure. AIMS: To examine lifetime blood pressure as a predictor of brain structure in old age. METHOD: A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities. RESULTS: Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy. CONCLUSIONS: Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose-response pattern.

Original publication




Journal article


Br J Psychiatry

Publication Date





308 - 315


Age Distribution, Aged, Aged, 80 and over, Atrophy, Blood Pressure, Brain, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, Dementia, Depressive Disorder, Female, Follow-Up Studies, Humans, Hypertension, Magnetic Resonance Imaging, Male, Middle Aged, Radionuclide Imaging, Risk Factors, Sex Distribution