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Risk Factor:
  (BP, DBP, diastolic, diastolic blood pressure, hypertension, hypotension, pulse pressure, SBP, systolic, systolic blood pressure)
Risk Factor Type: Chronic disease, Metabolic
Current Understanding:
The tables below present inconsistent data on the relationship between blood pressure and AD and total dementia. There is a suggestion of an age-dependent relationship, i.e., hypertension may be harmful in midlife and protective in late-life. However, few studies have specifically considered the association between midlife blood pressure and AD, and it is possible that that bias (in particular reverse causation or selection bias) might account for any protective association in late-life. Further research is necessary and should focus on the impact of blood pressure in midlife, on potential modifying effect of anti-hypertensive drug use, and on quantifying the potential that selection bias or reverse causation might account for the observed associations. Despite the uncertainty regarding the relationship between blood pressure and risk of AD, the benefits of blood pressure control on cardiovascular risk are sufficient to justify current treatment standards. For a discussion of the putative mechanisms by which blood pressure may influence AD risk and commentary on interpreting the findings below in a broader context, please see the Discussion. A longer review and discussion can be found in the published review and meta-analysis, Power MC, Weuve J, Gagne JJ, McQueen MB, Viswanathan A, Blacker D. The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis (Epidemiology 2011;22:646-659).
Literature Extraction: Search strategy  * New *
Last Search Completed: 01 November 2011 - Last content update released on 1 Nov 2012.

Table 1:  Hypertension - categorical
Table 2:  Systolic blood pressure - categorical
Table 3:  Diastolic blood pressure - categorical
Table 4:  Systolic blood pressure - untreated - categorical
Table 5:  Systolic blood pressure - treated - categorical
Table 6:  Diastolic blood pressure - untreated - categorical
Table 7:  Diastolic blood pressure - treated - categorical
Table 8:  Pulse pressure - categorical
Table 9:  Postural hypotension - categorical
Table 10:  Systolic blood pressure - continuous, per 10 mm Hg increase
Table 11:  Diastolic blood pressure - continuous, per 10 mm Hg increase
Table 12:  Systolic blood pressure - untreated - continuous, per 10 mm Hg increase
Table 13:  Systolic blood pressure - treated - continuous, per 10 mm Hg increase
Table 14:  Diastolic blood pressure - untreated - continuous, per 10 mm Hg increase
Table 15:  Diastolic blood pressure - treated - continuous, per 10 mm Hg increase
Table 16:  Pulse pressure - continuous, per 10 mm Hg increase
Table 17:  Mean arterial pressure - continuous, per 10 mm Hg increase

Table 1:   Hypertension - categorical
Meta-Analysis
Notes These reports examine the relationship between the presence of hypertension and AD. Most, but not all studies in this table relied on self report to assess the presence of hypertension. In the exposure distribution column, the term "history of hypertension" is used for studies that classified the presence of hypertension as prevalent hypertension at baseline or as a history of the condition. Hypertension may develop at different times throughout the lifespan, and the studies varied in their focus on the timing of their participants’ diagnoses. Some assessed participants’ hypertension status multiple times during follow-up, while others did not provide information about the age at hypertension diagnosis. Abbreviations: Htn, hypertension; Hx, history  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Bermejo-Pareja, 2010 NEDICES Incidence study reporting hazard ratios (HRs) 3824
(57%)
3.2 y
(detail)
No hx of htn at baseline: 49%
Drug-treated hx of htn at baseline: 43%
Untreated hx of htn at baseline: 8%
(detail)
43
58
12
Total: 113
1.00
1.40
2.07
Ref.
0.89-2.20
0.98-4.37
Ref.
0.14
0.06
62
78
19
Total: 159
1.00
1.28
2.37
Ref.
0.87-1.90
1.32-4.27
Ref.
0.21
0.004
 (detail) 73 (6)
(63 - )
(detail)
Screening: MMSE, Other, Pfeffer FAQ

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, CHD, DEP, DM, HC, RES, SD, SH‡
(detail)
Bermejo-Pareja, 2010
Chiang, 2007 MRMD & CSP Combo Nested case control study with cumulative incidence sampling reporting odds ratios (ORs) 785
(41%)
-
(detail)
No hx of htn at baseline:         
Hx of htn at baseline:         
(detail)
57
16
Total: 73
1.00
1.40
Ref.
0.75-2.62
Ref.
0.29
*
126
31
Total: 157
1.00
1.41
Ref.
0.89-2.22
Ref.
0.14
*
Other
(detail)
58 (7)
(30 - )
(detail)
Screening: Other

AD Diagnosis: DSM IV
(detail)
A, G, O, SP‡
(detail)
Chiang, 2007
Forti, 2010 CSBA Incidence study reporting hazard ratios (HRs) 466
(51%)
3.9 y
(detail)
Age 65-74 y at baseline
No htn at baseline: 12%
Htn at baseline: 88%
(detail)

2
16
Total: 18

1.00†
0.77

Ref.
0.17-3.52

Ref.
0.74
*

5
30
Total: 35

1.00†
0.44

Ref.
0.16-1.23

Ref.
0.11
*
Caucasian
(detail)
69 (3)
(65 - 74)
(detail)
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, AO, APOE4, CVD, HDL, HG, HHC, HTG, IS, SL, SH‡
(detail)
Forti, 2010
Forti, 2010 CSBA Incidence study reporting hazard ratios (HRs) 283
(57%)
3.9 y
(detail)
Age 75+ y at baseline
No htn at baseline: 14%
Htn at baseline: 86%
(detail)

6
29
Total: 35

1.00
0.97

Ref.
0.39-2.40

Ref.
0.95
*

7
45
Total: 52

1.00
1.21

Ref.
0.53-2.74

Ref.
0.65
*
Caucasian
(detail)
80 (4)
(75 - )
(detail)
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, AO, APOE4, CVD, HDL, HG, HHC, HTG, IS, SL, SH‡
(detail)
Forti, 2010
Hayden, 2006 Cache County Study Incidence study reporting hazard ratios (HRs) 3264
(58%)
3.2 y
(detail)
No hx of htn at baseline: 49%
Hx of htn at baseline: 51%
(detail)
54
50
Total: 104
1.00
0.66
Ref.
0.43-1.02
Ref.
0.06
*
63
78
Total: 141
1.00
0.82
Ref.
0.56-1.20
Ref.
0.31
*
 (detail) 74 (6)
(65 - )
(detail)
Screening: "Modified" 3MSE, Age, DQ, IQ-CODE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, CABG, DM, HC, MI, OB, SH‡
(detail)
Hayden, 2006
Kuller, 2003 CHCS Incidence study reporting hazard ratios (HRs) 2939
(59%)
-
(detail)
No htn: 56%
Htn: 44%
(detail)
-
-
Total: 330
1.00
0.90
Ref.
0.71-1.19
Ref.
0.42
*
248
232
Total: 480
1.00
1.00
Ref.
0.94-1.27
Ref.
1.0
*
Caucasian
- (-)
(65 - )
(detail)
Screening: IQ-CODE, 3MSE, Other, TICS

AD Diagnosis: Other
(detail)
A, E, G, APOE4, MMSE, DM, MI, O, RE, SH‡
(detail)
Kuller, 2003
Lindsay, 2002 CSHA Cumulative incidence study reporting odds ratios (ORs) 4088
(58%)
5.0 y
*

(detail)
No hx of htn: 67%
Hx of Htn: 33%
(detail)
98
59
Total: 157
1.00
0.88
Ref.
0.62-1.27
Ref.
0.48
*
 
 
       (detail) 68 (-)
(65 - 100)
(detail)
Screening: 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Lindsay, 2002
Luchsinger, 2005 WHICAP Incidence study reporting hazard ratios (HRs) 1138
(70%)
5.5 y
(detail)
No htn: 39%
Htn: 61%
(detail)
78
168
Total: 246
1.00
1.50
Ref.
0.90-2.40
Ref.
0.11
*
 
 
      Caucasian, Hispanic, African-American (Black)
76 (6)
(65 - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Luchsinger, 2005
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
No hx of htn at baseline: 63%
Hx of htn at baseline: 37%
(detail)
-
-
Total: 99
1.00
1.13
Ref.
0.60-2.13
Ref.
0.71
*
 
 
       (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 378
(-)
14 y
(detail)
No htn (Age 54+ and Age 65+): 26%
Mixed history (Age 54+ and Age 65+): 62%
Htn (Age 54+ and Age 65+): 12%
(detail)
-
-
-
Total: 41
1.00
0.92
1.10
Ref.
0.39-2.20
0.19-6.44
Ref.
0.85
0.92
*
 
 
 
       (detail) - (-)
(54 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Muller, 2007 WHICAP Incidence study reporting hazard ratios (HRs) 2069
(67%)
4.4 y
(detail)
No htn: 27%
Htn: 73%
(detail)
-
-
Total: 147
1.00
1.50
Ref.
0.90-2.40
Ref.
0.11
*
-
-
Total: 236
1.00
1.20
Ref.
0.90-1.70
Ref.
0.26
*
Caucasian, Hispanic, African-American (Black)
(detail)
76 (6)
(65 - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE, SM, SP‡
(detail)
Muller, 2007
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 668
(60%)
14 y
*

(detail)
Normal (JNC-7) at baseline: 16%
Prehypertension (JNC-7) at baseline: 34%
Stage 1 Hypertension (JNC-7) at baseline: 30%
Stage 2 Hypertension (JNC-7) at baseline: 20%
(detail)
22
39
39
23
Total: 123
1.00
0.74
0.93
0.67
Ref.
0.42-1.27
0.52-1.65
0.33-1.37
Ref.
0.27
0.8
0.27
33
71
75
53
Total: 232
1.00
0.89
1.12
1.16
Ref.
0.57-1.39
0.71-1.79
0.68-1.98
Ref.
0.6
0.62
0.59
Japanese
72 (4)
(65 - 79)
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, DM, O, HCY, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 534
(61%)
28 y
*

(detail)
Normal (JNC-7) at midlife: 23%
Prehypertension (JNC-7) at midlife: 35%
Stage 1 Hypertension (JNC-7) at midlife: 29%
Stage 2 Hypertension (JNC-7) at midlife: 14%
(detail)
26
33
31
12
Total: 102
1.00
0.77
1.26
1.05
Ref.
0.45-1.31
0.72-2.21
0.50-2.22
Ref.
0.34
0.42
0.89
38
56
66
33
Total: 193
1.00
0.92
1.73
1.95
Ref.
0.60-1.41
1.12-2.65
1.18-3.24
Ref.
0.71
0.01
0.01
Japanese
57 (4)
( - )
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, O, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Ogunniyi, 2006 Indianapolis-Ibadan Dementia Project - Indianapolis Cohort Cumulative incidence study reporting odds ratios (ORs) 470
(69%)
-
(detail)
Indianapolis cohort
No hx of htn at baseline:         
Hx of htn at baseline:         
(detail)

-
-
Total: 89

1.00
0.97

Ref.
0.59-1.63

Ref.
0.91
*

 
 

 

 

 
African-American (Black)
(detail)
74 (-)
(65 - )
(detail)
Screening: CSID

AD Diagnosis: NINCDS ADRDA
(detail)
A, G‡
(detail)
Ogunniyi, 2006
Ogunniyi, 2006 Indianapolis-Ibadan Dementia Project - Ibadan Cohort Cumulative incidence study reporting odds ratios (ORs) 523
(64%)
-
(detail)
Ibadan cohort
No hx of htn at baseline:         
Hx of htn at baseline:         
(detail)

-
-
Total: 62

1.00
0.33

Ref.
0.10-0.85

Ref.
0.04
*

 
 

 

 

 
African
(detail)
74 (-)
(65 - )
(detail)
Screening: CSID

AD Diagnosis: NINCDS ADRDA
(detail)
A, G‡
(detail)
Ogunniyi, 2006
Raffaitin, 2009 3C Incidence study reporting hazard ratios (HRs) 7087
(61%)
3.5 y
*

(detail)
No htn at baseline: 14%
Htn at baseline: 86%
(detail)
-
-
Total: 134
1.00
1.06
Ref.
0.58-1.92
Ref.
0.86
-
-
Total: 208
1.00
1.07
Ref.
0.66-1.72
Ref.
0.79
Caucasian
(detail)
73 (5)
(65 - )
(detail)
Screening: MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, SP‡
(detail)
Raffaitin, 2009
Shah, 2006 ROS Incidence study reporting hazard ratios (HRs) 824
(69%)
6.0 y
*

(detail)
No hx of htn at baseline: 59%
Hx of htn at baseline: 41%
(detail)
-
-
Total: 151
1.00
0.85
Ref.
0.61-1.18
Ref.
0.33
 
 
      Caucasian, Other
(detail)
75 (7)
( - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Shah, 2006
Solfrizzi, 2010 ILSA Incidence study reporting hazard ratios (HRs) 2097
(47%)
3.5 y
(detail)
No htn at baseline: 20%
Htn at baseline: 80%
(detail)
29
18
Total: 47
1.00
0.81
Ref.
0.39-1.69
Ref.
0.57
*
57
31
Total: 88
1.00
0.80
Ref.
0.46-1.37
Ref.
0.42
*
  73 (6)
( - )
Screening: Informant interview, MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ALC, CAD, DEP, FG, NHDL, O, SM, SH‡ Solfrizzi, 2010
Tyas, 2001 MSHA Cumulative incidence study reporting odds ratios (ORs) 694
(62%)
5.0 y
*

(detail)
No hx of htn at baseline: 68%
Hx of htn at baseline: 32%
(detail)
23
12
Total: 35
1.00
1.14
Ref.
0.53-2.45
Ref.
0.74
*
 
 
       (detail) 74 (6)
(65 - 93)
(detail)
Screening: "Modified" 3MSE, 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡ Tyas, 2001
Yang, 2011 Saint Louis ADRC Cohorts Incidence study reporting hazard ratios (HRs) 594
(59%)
6.7 y
(detail)
No hx of htn at baseline: 71%
Hx of htn at baseline: 29%
(detail)
159
58
Total: 217
1.00
0.82
Ref.
0.58-1.15
Ref.
0.25
 
 
      Caucasian, Other, African-American (Black)
76 (9)
( - )
Screening: CDR, Informant interview, Other

AD Diagnosis: DSM IIIR, NINCDS ADRDA
(detail)
A, E, G, APOE234, RE‡
(detail)
Yang, 2011
* Derived value.
† Five or fewer cases exist.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "AO" (abdominal obeisity), "ALC" (alcohol intake), "AHD" (antihypertensive drug use), "APOE234" (APOE e2 e3 e4 genotype), "APOE4" (APOE e4 genotype), "MMSE" (baseline MMSE), "BMI" (body mass index), "CVD" (cardiovascular disease), "CABG" (coronary artery bypass graft), "CAD" (coronary artery disease), "CHD" (coronary heart disease), "DEP" (depression), "DM" (diabetes mellitus), "FG" (fibrogen), "HDL" (HDL cholesterol), "HC" (high cholesterol), "HG" (hyperglycemia), "HHC" (hyperhomocysteinemia), "HTG" (hypertriglyceridemia), "IS" (inflammation status), "IDD" (interval to disease diagnosis), "MI" (mycardial infarction history), "NHDL" (non-HDL cholesterol), "O" (other), "OB" (overweight/obesity), "HCY" (plasma homocysteine), "RE" (race/ethnicity), "RES" (residential township), "SL" (sedentary lifestyle), "SCH" (serum cholesterol), "SD" (sleep duration), "SM" (smoking status), "SS" (stratified sampling), "SH" (stroke history), "SP" (study population)
 
Table 2:   Systolic blood pressure - categorical
Notes These papers examine the relationship between categories of systolic blood pressure (SBP) and AD. Most authors used standard categories of SBP to align with clinical definitions of hypertension. The referents for comparison vary across the papers. Some papers defined a relatively “hypotensive” exposure group that was compared with a referent of mid-level SBP. The age at which blood pressure measurements were taken appears to be important. Generally, elevated SBP at younger ages is associated with an increased risk of AD, while elevated SBP at older ages is associated with a lower risk of AD  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Kivipelto, 2002 NKP-FINMONICA-CAIDE Cumulative incidence study reporting odds ratios (ORs) 1287
(62%)
21 y
(detail)
<140 mm Hg at baseline:         
140-159 mm Hg at baseline:         
160+ mm Hg at baseline:         
(detail)
-
-
-
Total: 48
1.00
1.60
2.60
Ref.
0.70-4.20
1.10-6.60
Ref.
0.3
0.04
*
-
-
-
Total: 52
1.00
1.90
2.80
Ref.
0.80-4.80
1.10-7.20
Ref.
0.16
0.03
*
 (detail) 50 (6)
( - )
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ALC, APOE4, SM‡
(detail)
Kivipelto, 2002
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<140 mm Hg at baseline: 51%
140-159 mm Hg at baseline: 30%
160+ mm Hg at baseline: 19%
(detail)
23
19
14
Total: 56
1.00
1.47
1.38
Ref.
0.80-2.71
0.71-2.70
Ref.
0.22
0.34
*
45
34
31
Total: 110
1.00
1.32
1.60
Ref.
0.84-2.07
1.01-2.55
Ref.
0.23
0.05
*
Caucasian
- (-)
(65 - 74)
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<140 mm Hg at baseline: 41%
140-159 mm Hg at baseline: 34%
160+ mm Hg at baseline: 25%
(detail)
58
31
37
Total: 126
1.00
0.60
0.94
Ref.
0.38-0.92
0.62-1.42
Ref.
0.02
0.77
*
86
62
66
Total: 214
1.00
0.83
1.18
Ref.
0.60-1.15
0.85-1.62
Ref.
0.26
0.31
*
Caucasian
- (-)
(75 - 84)
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<140 mm Hg at baseline: 37%
140-159 mm Hg at baseline: 29%
160+ mm Hg at baseline: 35%
(detail)
10
4
6
Total: 20
1.00
0.48†
0.70
Ref.
0.15-1.57
0.25-1.95
Ref.
0.22
0.5
*
20
20
14
Total: 54
1.00
1.06
0.64
Ref.
0.55-2.04
0.32-1.30
Ref.
0.86
0.21
*
Caucasian
- (-)
(85 - )
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
<130 mm Hg at baseline: 23%
130-139 mm Hg at baseline: 23%
140-149 mm Hg at baseline: 18%
150-159 mm Hg at baseline: 14%
160+ mm Hg at baseline: 21%
(detail)
-
-
-
-
-
Total: 99
0.87
1.00
0.50
0.34
0.29
0.37-2.06
Ref.
0.21-1.19
0.11-1.07
0.10-0.86
0.75
Ref.
0.12
0.06
0.02
*
 
 
 
 
 
       (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 378
(-)
14 y
(detail)
<160 mm Hg at baseline: 86%
160+ mm Hg at baseline: 14%
(detail)
-
-
Total: 41
1.00
1.13
Ref.
0.24-5.37
Ref.
0.88
*
 
 
       (detail) - (-)
(54 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 668
(60%)
14 y
*

(detail)
<110 mm Hg at baseline: 7%
110-119 mm Hg at baseline: 9%
120-139 mm Hg at baseline: 34%
140-159 mm Hg at baseline: 30%
160+ mm Hg at baseline: 20%
(detail)
12
10
39
39
23
Total: 123
1.66
1.00
0.92
1.22
1.06
0.71-3.88
Ref.
0.46-1.89
0.59-2.53
0.47-2.40
0.24
Ref.
0.84
0.58
0.89
15
18
72
24
53
Total: 182
1.06
1.00
0.88
1.10
1.16
0.53-2.12
Ref.
0.52-1.49
0.64-1.89
0.64-2.10
0.87
Ref.
0.63
0.73
0.62
Japanese
72 (4)
(65 - 79)
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, O, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 534
(61%)
28 y
*

(detail)
<110 mm Hg at midlife: 9%
110-119 mm Hg at midlife: 10%
120-139 mm Hg at midlife: 29%
140-159 mm Hg at midlife: 21%
160+ mm Hg at midlife: 11%
(detail)
12
15
34
29
12
Total: 102
0.83
1.00
0.72
1.13
0.99
0.39-1.80
Ref.
0.39-1.35
0.59-2.17
0.44-2.23
0.65
Ref.
0.31
0.72
0.98
17
22
60
61
33
Total: 193
0.85
1.00
0.91
1.60
1.87
0.45-1.62
Ref.
0.55-1.51
0.96-2.66
1.05-3.32
0.62
Ref.
0.72
0.07
0.03
Japanese
57 (4)
( - )
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, O, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 1270
(75%)
4.3 y
*

(detail)
<141 mm Hg at baseline: 31%
141-180 mm Hg at baseline: 60%
181+ mm Hg at baseline: 9%
(detail)
83
145
28
Total: 256
1.00
1.00
1.50
0.80-1.30
Ref.
1.00-2.30
1.0
Ref.
0.07
*
108
192
39
Total: 339
1.00
1.00
1.60
0.80-1.30
Ref.
1.10-2.20
1.0
Ref.
0.01
*
 (detail) 82 (5)
(75 - 101)
(detail)
AD Diagnosis: Other
(detail)
A, E, G, AHD, MMSE, DBP, VD‡
(detail)
Qiu, 2003
Ronnemaa, 2011 ULSAM Incidence study reporting hazard ratios (HRs) 1174
(0%)
13 y
(detail)
<140 mm Hg at late life:         
140+ mm Hg at late life:         
(detail)
-
-
Total: 106
1.00
1.00
Ref.
0.80-1.20
Ref.
1.0
*
-
-
Total: 246
1.00
1.20
Ref.
1.00-1.30
Ref.
0.007
  71 (1)
( - )
(detail)
AD Diagnosis: Medical History, NINCDS ADRDA
(detail)
A, E‡ Ronnemaa, 2011
Ronnemaa, 2011 ULSAM Incidence study reporting hazard ratios (HRs) 2268
(0%)
29 y
(detail)
<140 mm Hg at midlife:         
140+ mm Hg at midlife:         
(detail)
-
-
Total: 127
1.00
1.00
Ref.
0.80-1.20
Ref.
1.0
*
-
-
Total: 349
1.00
1.20
Ref.
1.00-1.30
Ref.
0.007
  50 (1)
( - )
(detail)
AD Diagnosis: Medical History, NINCDS ADRDA
(detail)
A, E‡ Ronnemaa, 2011
Verghese, 2003 Bronx Aging Study Incidence study reporting hazard ratios (HRs) 406
(64%)
6.7 y
*

(detail)
<111 mm Hg at baseline: 3%
111-139 mm Hg at baseline: 34%
140-179 mm Hg at baseline: 42%
180+ mm Hg at baseline: 21%
(detail)
1
31
21
12
Total: 65
-
1.00
0.55
0.68
-
Ref.
0.32-0.96
0.35-1.32
-
Ref.
0.03
0.25
*
4
50
44
24
Total: 122
0.81†
1.00
0.72
0.86
0.32-2.45
Ref.
0.48-1.08
0.52-1.40
0.68
Ref.
0.11
0.55
*
Caucasian
(detail)
79 (3)
(75 - 85)
(detail)
Screening: Blessed, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Verghese, 2003
* Derived value.
† Five or fewer cases exist.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "AHD" (antihypertensive drug use), "APOE4" (APOE e4 genotype), "MMSE" (baseline MMSE), "BMI" (body mass index), "DBP" (diastolic blood pressure), "IDD" (interval to disease diagnosis), "O" (other), "RE" (race/ethnicity), "SCH" (serum cholesterol), "SM" (smoking status), "SS" (stratified sampling), "SH" (stroke history), "VD" (vascular disease)
 
Table 3:   Diastolic blood pressure - categorical
Notes These papers examine the relationship between categories of diastolic blood pressure (DBP) and AD. Most authors used standard categories of DBP to align with clinical definitions of hypertension. The referents for comparison vary across the papers. Some papers defined a relatively “hypotensive” exposure group that was compared with a referent of mid-level DBP. The age at which blood pressure measurements were taken appears to be important. Generally, elevated DBP at younger ages is associated with an increased risk of AD while higher diastolic blood pressure at older ages is associated with a lower risk of AD.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Kivipelto, 2002 NKP-FINMONICA-CAIDE Cumulative incidence study reporting odds ratios (ORs) 1287
(62%)
21 y
(detail)
<90 mm Hg at baseline:         
90-94 mm Hg at baseline:         
95+ mm Hg at baseline:         
(detail)
-
-
-
Total: 48
1.00
1.20
2.00
Ref.
0.40-3.30
0.90-4.60
Ref.
0.73
0.1
*
-
-
-
Total: 52
1.00
1.40
2.30
Ref.
0.50-3.60
1.10-5.10
Ref.
0.5
0.03
*
 (detail) 50 (6)
( - )
Screening: MMSE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, ALC, APOE4, SM‡
(detail)
Kivipelto, 2002
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<80 mm Hg at baseline: 60%
80-89 mm Hg at baseline: 30%
90+ mm Hg at baseline: 10%
(detail)
30
22
4
Total: 56
1.00
1.71
0.82†
Ref.
0.98-2.97
0.29-2.35
Ref.
0.06
0.71
*
60
43
7
Total: 110
1.00
1.59
0.69
Ref.
1.07-2.35
0.31-1.52
Ref.
0.02
0.36
*
Caucasian
- (-)
(65 - 74)
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<80 mm Hg at baseline: 69%
80-89 mm Hg at baseline: 24%
90+ mm Hg at baseline: 7%
(detail)
91
28
7
Total: 126
1.00
0.96
0.73
Ref.
0.63-1.47
0.34-1.59
Ref.
0.85
0.42
*
143
55
16
Total: 214
1.00
1.18
1.12
Ref.
0.87-1.61
0.66-1.88
Ref.
0.16
0.27
*
Caucasian
- (-)
(75 - 84)
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Li, 2007 ACT-GHC Incidence study reporting hazard ratios (HRs) -
(-)
-
(detail)
<80 mm Hg at baseline: 72%
80-89 mm Hg at baseline: 23%
90+ mm Hg at baseline: 5%
(detail)
14
6
0
Total: 20
1.00
1.58
-
Ref.
0.58-4.29
-
Ref.
0.37
-
*
38
16
0
Total: 54
1.00
1.29
-
Ref.
0.70-2.38
-
Ref.
0.41
-
*
Caucasian
- (-)
(85 - )
(detail)
Screening: CASI

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G, APOE4, RE‡
(detail)
Li, 2007
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
<70 mm Hg at baseline: 21%
70-79 mm Hg at baseline: 37%
80-89 mm Hg at baseline: 30%
80+ mm Hg at baseline: 12%
(detail)
-
-
-
-
Total: 99
1.81
0.90
1.00
0.74
0.77-4.29
0.42-1.92
Ref.
0.23-2.40
0.18
0.79
Ref.
0.61
*
 
 
 
 
       (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 378
(-)
14 y
(detail)
<90 mm Hg at baseline: 79%
90+ mm Hg at baseline: 21%
(detail)
-
-
Total: 41
1.00
1.56
Ref.
0.46-5.32
Ref.
0.48
*
 
 
       (detail) - (-)
(54 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 668
(60%)
14 y
*

(detail)
<70 mm Hg at baseline: 34%
70-79 mm Hg at baseline: 48%
80-84 mm Hg at baseline: 20%
85-89 mm Hg at baseline: 10%
90+ mm Hg at baseline: 13%
(detail)
40
51
15
8
9
Total: 123
1.06
1.00
0.70
0.89
0.74
0.69-1.65
Ref.
0.39-1.26
0.42-1.89
0.35-1.55
0.78
Ref.
0.24
0.76
0.42
64
92
35
17
24
Total: 232
0.88
1.00
0.85
0.83
0.99
0.63-1.23
Ref.
0.57-1.27
0.49-1.41
0.62-1.59
0.44
Ref.
0.44
0.5
0.97
Japanese
72 (4)
(65 - 79)
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, O, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 534
(61%)
28 y
*

(detail)
<70 mm Hg at midlife: 18%
70-79 mm Hg at midlife: 34%
80-84 mm Hg at midlife: 20%
85-89 mm Hg at midlife: 12%
90+ mm Hg at midlife: 17%
(detail)
18
36
22
9
17
Total: 102
0.91
1.00
1.31
1.01
1.67
0.50-1.63
Ref.
0.76-2.26
0.48-2.13
0.90-3.10
0.74
Ref.
0.33
0.98
0.1
30
62
42
18
41
Total: 193
0.88
1.00
1.27
1.12
2.29
0.56-1.38
Ref.
0.85-1.91
0.65-1.92
1.50-3.51
0.57
Ref.
0.24
0.68
0.001
Japanese
57 (4)
( - )
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, O, SCH, SM, SH‡
(detail)
Ninomiya, 2011
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 1270
(75%)
4.3 y
*

(detail)
<66 mm Hg at baseline: 10%
66-90 mm Hg at baseline: 75%
91+ mm Hg at baseline: 14%
(detail)
34
191
31
Total: 256
1.70
1.00
0.80
1.10-2.40
Ref.
0.50-1.20
0.01
Ref.
0.32
*
40
255
44
Total: 339
1.50
1.00
0.90
1.00-2.10
Ref.
0.60-1.20
0.03
Ref.
0.55
*
 (detail) 82 (5)
(75 - 101)
(detail)
AD Diagnosis: Other
(detail)
A, E, G, AHD, MMSE, SBP, VD‡
(detail)
Qiu, 2003
Verghese, 2003 Bronx Aging Study Incidence study reporting hazard ratios (HRs) 406
(64%)
6.7 y
*

(detail)
<71 mm Hg at baseline: 14%
71-89 mm Hg at baseline: 58%
90-109 mm Hg at baseline: 26%
110+ mm Hg at baseline: 1%
(detail)
15
39
11
0
Total: 65
1.64
1.00
0.63
-
1.04-2.61
Ref.
0.39-1.02
-
0.04
Ref.
0.06
-
*
24
75
22
1
Total: 122
1.91
1.00
0.63
-
1.05-3.48
Ref.
0.32-12.30
-
0.03
Ref.
0.62
-
*
Caucasian
(detail)
79 (3)
(75 - 85)
(detail)
Screening: Blessed, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Verghese, 2003
* Derived value.
† Five or fewer cases exist.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "AHD" (antihypertensive drug use), "APOE4" (APOE e4 genotype), "MMSE" (baseline MMSE), "BMI" (body mass index), "IDD" (interval to disease diagnosis), "O" (other), "RE" (race/ethnicity), "SCH" (serum cholesterol), "SM" (smoking status), "SS" (stratified sampling), "SH" (stroke history), "SBP" (systolic blood pressure), "VD" (vascular disease)
 
Table 4:   Systolic blood pressure - untreated - categorical
Notes These reports consider the relationship between categories of systolic blood pressure and AD among those who were not receiving medical treatment for hypertension, whether or not they had hypertension. Criteria for being classified as "treated" or "untreated" vary from study to study (e.g., baseline vs. ever), and we have included these definitions in the detail text.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Launer, 2000 HAAS Cumulative incidence study reporting odds ratios (ORs) 2133
(0%)
27 y
(detail)
<110 mm Hg at midlife:         
110-139 mm Hg at midlife:         
140-159 mm Hg at midlife:         
159+ mm Hg at midlife:         
Mixed SBP hx at midlife:         
(detail)
-
-
-
-
-
Total: 87
1.37
1.00
1.15
1.75
0.22
0.68-2.75
Ref.
0.59-2.23
0.58-5.29
0.05-1.00
0.38
Ref.
0.68
0.32
0.05
*
-
-
-
-
-
Total: 119
1.32
1.00
1.13
4.85
0.42
0.71-2.45
Ref.
0.62-2.06
1.99-11.83
0.15-1.22
0.38
Ref.
0.69
0.001
0.1
*
Japanese-American
(detail)
53 (5)
(45 - 68)
(detail)
Screening: Age, CASI, IQ-CODE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, ALC, APOE234, SM‡
(detail)
Launer, 2000
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 703
(-)
-
(detail)
<141 mm Hg at baseline: 33%
141-180 mm Hg at baseline: 59%
181+ mm Hg at baseline: 8%
(detail)
52
92
19
Total: 163
1.00
1.00
1.60
0.70-1.40
Ref.
0.90-2.60
1.0
Ref.
0.08
*
66
116
22
Total: 204
1.00
1.00
1.50
0.80-1.40
Ref.
0.90-2.40
1.0
Ref.
0.11
*
 (detail) - (-)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G, MMSE, DBP, VD‡
(detail)
Qiu, 2003
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "APOE234" (APOE e2 e3 e4 genotype), "MMSE" (baseline MMSE), "DBP" (diastolic blood pressure), "SM" (smoking status), "VD" (vascular disease)
 
Table 5:   Systolic blood pressure - treated - categorical
Notes These reports consider the relationship between categories of systolic blood pressure and AD among those who were medically treated for hypertension. Criteria for being classified as "treated" or "untreated" vary from study to study (e.g., baseline vs. ever), and we have included these definitions in the detail text.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Launer, 2000 HAAS Cumulative incidence study reporting odds ratios (ORs) 1570
(0%)
27 y
(detail)
<110 mm Hg at midlife:         
110-139 mm Hg at midlife:         
140-159 mm Hg at midlife:         
159+ mm Hg at midlife:         
Mixed SBP hx at midlife:         
(detail)
-
-
-
-
-
Total: 31
-
1.00
0.96
0.83
0.99
-
Ref.
0.38-2.42
0.27-2.57
0.28-3.44
-
Ref.
0.93
0.75
0.99
*
-
-
-
-
-
Total: 78
2.22
1.00
0.84
1.69
0.53
0.47-10.54
Ref.
0.44-1.57
0.90-3.20
0.20-1.39
0.31
Ref.
0.59
0.1
0.2
*
Japanese-American
(detail)
53 (5)
(45 - 68)
(detail)
Screening: Age, CASI, IQ-CODE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, ALC, APOE234, SM‡
(detail)
Launer, 2000
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 567
(-)
-
(detail)
<141 mm Hg at baseline: 29%
141-180 mm Hg at baseline: 62%
181+ mm Hg at baseline: 9%
(detail)
31
53
9
Total: 93
1.00
1.00
1.40
0.70-1.60
Ref.
0.70-2.90
1.0
Ref.
0.35
*
42
76
17
Total: 135
1.00
1.00
1.70
0.70-1.50
Ref.
1.00-2.90
1.0
Ref.
0.06
*
 (detail) - (-)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G, MMSE, DBP, VD‡
(detail)
Qiu, 2003
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "APOE234" (APOE e2 e3 e4 genotype), "MMSE" (baseline MMSE), "DBP" (diastolic blood pressure), "SM" (smoking status), "VD" (vascular disease)
 
Table 6:   Diastolic blood pressure - untreated - categorical
Notes These reports consider the relationship between categories of diastolic blood pressure and AD among those who were not receiving medical treatment for hypertension, whether or not they had hypertension. Criteria for being classified as "treated" or "untreated" vary from study to study (e.g. baseline vs. ever), and we have included these definitions in the detail text.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Launer, 2000 HAAS Cumulative incidence study reporting odds ratios (ORs) 2133
(0%)
27 y
(detail)
<80 mm Hg at midlife:         
80-89 mm Hg at midlife:         
90-94 mm Hg at midlife:         
95+ mm Hg at midlife:         
Mixed DBP hx at midlife:         
(detail)
-
-
-
-
-
Total: 87
1.81
1.00
3.61
4.61
1.39
0.99-3.33
Ref.
1.36-9.60
1.61-13.19
0.57-3.35
0.06
Ref.
0.01
0.004
0.47
*
-
-
-
-
-
Total: 119
1.52
1.00
3.78
4.32
1.80
0.90-2.56
Ref.
1.64-8.74
1.72-10.85
0.87-3.69
0.12
Ref.
0.002
0.002
0.11
*
Japanese-American
(detail)
53 (5)
(45 - 68)
(detail)
Screening: Age, CASI, IQ-CODE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, ALC, APOE234, SM‡
(detail)
Launer, 2000
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 703
(-)
-
(detail)
<66 mm Hg at baseline: 10%
66-90 mm Hg at baseline: 76%
91+ mm Hg at baseline: 14%
(detail)
17
122
24
Total: 163
1.30
1.00
1.00
0.80-2.20
Ref.
0.60-1.60
0.31
Ref.
1.0
*
20
154
30
Total: 204
1.20
1.00
1.00
0.80-2.00
Ref.
0.70-1.60
0.44
Ref.
1.0
*
 (detail) - (-)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G, MMSE, SBP, VD‡
(detail)
Qiu, 2003
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "APOE234" (APOE e2 e3 e4 genotype), "MMSE" (baseline MMSE), "SM" (smoking status), "SBP" (systolic blood pressure), "VD" (vascular disease)
 
Table 7:   Diastolic blood pressure - treated - categorical
Notes These reports consider the relationship between categories of diastolic blood pressure and AD among those who were medically treated for hypertension. Criteria for being classified as "treated" or "untreated" vary from study to study (e.g. baseline vs. ever), and we have included these definitions in the detail text.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Launer, 2000 HAAS Cumulative incidence study reporting odds ratios (ORs) 1570
(0%)
27 y
(detail)
<80 mm Hg at midlife:         
80-89 mm Hg at midlife:         
90-94 mm Hg at midlife:         
95+ mm Hg at midlife:         
Mixed DBP hx at midlife:         
(detail)
-
-
-
-
-
Total: 31
1.29
1.00
0.71
0.15
1.33
0.47-3.59
Ref.
0.18-2.86
0.02-1.18
0.51-3.49
0.62
Ref.
0.63
0.07
0.56
*
-
-
-
-
-
Total: 78
1.74
1.00
1.07
0.82
1.38
0.87-3.46
Ref.
0.42-2.71
0.37-1.81
0.71-2.70
0.12
Ref.
0.89
0.62
0.34
*
Japanese-American
(detail)
53 (5)
(45 - 68)
(detail)
Screening: Age, CASI, IQ-CODE

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, ALC, APOE234, SM‡
(detail)
Launer, 2000
Qiu, 2003 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 567
(-)
-
(detail)
<66 mm Hg at baseline: 11%
66-90 mm Hg at baseline: 75%
91+ mm Hg at baseline: 14%
(detail)
17
69
7
Total: 93
2.50
1.00
0.50
1.40-4.30
Ref.
0.20-1.10
0.001
Ref.
0.11
*
20
101
14
Total: 135
1.90
1.00
0.60
1.10-3.10
Ref.
0.40-1.10
0.02
Ref.
0.05
*
 (detail) - (-)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G, MMSE, SBP, VD‡
(detail)
Qiu, 2003
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "APOE234" (APOE e2 e3 e4 genotype), "MMSE" (baseline MMSE), "SM" (smoking status), "SBP" (systolic blood pressure), "VD" (vascular disease)
 
Table 8:   Pulse pressure - categorical
Notes Pulse pressure is defined as systolic blood pressure minus diastolic blood pressure. High pulse pressure indicates the presence of atherosclerosis and arterial stiffness, and typically, pulse pressure increases with age. These reports investigate the relationship between pulse pressure and AD risk.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Qiu, 2003b Kungsholmen Project Incidence study reporting hazard ratios (HRs) 1270
(75%)
4.3 y
*

(detail)
<70 mm Hg at baseline: 37%
70-84 mm Hg at baseline: 31%
>84 mm Hg at baseline: 32%
(detail)
96
64
96
Total: 256
1.50
1.00
1.50
1.10-2.10
Ref.
1.10-2.00
0.01
Ref.
0.01
*
127
91
121
Total: 339
1.40
1.00
1.30
1.00-1.80
Ref.
1.00-1.80
0.01
Ref.
0.08
*
 (detail) 82 (5)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G‡
(detail)
Qiu, 2003b
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender)
 
Table 9:   Postural hypotension - categorical
Notes This report considers the relationship between postural hypotension and AD risk. Postural hypotension (orthostatic hypotension) is a drop in blood pressure that occurs when a person assumes a more vertical body position (e.g., from sitting to standing).  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Shah, 2006 ROS Incidence study reporting hazard ratios (HRs) 824
(69%)
6.0 y
*

(detail)
No postural hypotension: 95%
Postural hypotension: 5%
(detail)
-
-
Total: 151
1.00
0.99
Ref.
0.97-1.02
Ref.
0.55
 
 
      Caucasian, Other
(detail)
75 (7)
( - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Shah, 2006
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender)
 
Table 10:   Systolic blood pressure - continuous, per 10 mm Hg increase
Meta-Analysis
Notes The reports in this table evaluate the relationship between AD risk and systolic blood pressure (SBP), considered as a continuous variable. Such reports assume an exponential (i.e., log-linear) relationship between SBP and AD risk. We report findings over a uniform interval of SBP (effect size per 10-mm Hg increment in SBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
142 (-)
( - )
(detail)
99 0.82 0.72-0.95 0.01
*
         (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 378
(-)
14 y
(detail)
- (-)
( - )
(detail)
41 1.03 0.80-1.32 0.82
*
         (detail) - (-)
(54 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 668
(60%)
14 y
*

(detail)
142 (-)
( - )
(detail)
123 1.01 0.92-1.10 0.83 232 1.06 1.00-1.13 0.06 Japanese
72 (4)
(65 - 79)
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, DM, O, SCH, SM, SH‡ Ninomiya, 2011
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 534
(61%)
28 y
*

(detail)
136 (-)
( - )
(detail)
123 1.02 0.93-1.12 0.72 232 1.09 1.03-1.16 0.006 Japanese
57 (4)
( - )
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, DM, O, SCH, SM, SH‡ Ninomiya, 2011
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 6985
(60%)
2.1 y
(detail)
140.3 (23)
( - )
(detail)
124 0.96 0.89-1.03 0.27
*
196 0.93 0.88-0.99 0.02
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
Shah, 2006 ROS Incidence study reporting hazard ratios (HRs) 824
(69%)
6.0 y
*

(detail)
134 (10)
(90 - 209)
(detail)
151 0.95
*
0.87-1.04
*
0.25         Caucasian, Other
(detail)
75 (7)
( - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Shah, 2006
Verghese, 2003 Bronx Aging Study Incidence study reporting hazard ratios (HRs) 406
(64%)
6.7 y
*

(detail)
153.4 (24)
( - )
(detail)
65 0.92
*
0.83-1.02
*
0.1
*
122 0.93
*
0.87-1.01
*
0.08
*
Caucasian
(detail)
79 (3)
(75 - 85)
(detail)
Screening: Blessed, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Verghese, 2003
Yamada, 2003 AHS - RERF Cumulative incidence study reporting odds ratios (ORs) 1774
(73%)
25 y
*

(detail)
117 (-)
( - )
(detail)
51 1.03 - 0.001          (detail) - (-)
(30 - 80)
(detail)
Screening: CASI

AD Diagnosis: DSM IV
(detail)
A, E, G‡ Yamada, 2003
Yang, 2011   Incidence study reporting hazard ratios (HRs) 594
(59%)
6.7 y
(detail)
142.5 (22)
( - )
(detail)
217 1.00
*
0.95-1.05
*
0.29         Caucasian, Other, African-American (Black)
76 (9)
( - )
Screening: CDR, Informant interview, Other

AD Diagnosis: DSM IIIR, NINCDS ADRDA
(detail)
A, E, G, APOE234, RE‡
(detail)
Yang, 2011
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "AHD" (antihypertensive drug use), "APOE234" (APOE e2 e3 e4 genotype), "BMI" (body mass index), "DM" (diabetes mellitus), "IDD" (interval to disease diagnosis), "O" (other), "RE" (race/ethnicity), "SCH" (serum cholesterol), "SM" (smoking status), "SS" (stratified sampling), "SH" (stroke history), "SP" (study population)
 
Table 11:   Diastolic blood pressure - continuous, per 10 mm Hg increase
Meta-Analysis
Notes The reports in this table evaluate the relationship between AD risk and diastolic blood pressure (DBP), considered as a continuous variable. Such reports assume an exponential (i.e., log-linear) relationship between DBP and AD risk. We report findings over a uniform interval of DBP (effect size per 10-mm Hg increment in DBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
76 (-)
( - )
(detail)
99 0.74 0.53-1.01 0.07
*
         (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 378
(-)
14 y
(detail)
- (-)
( - )
(detail)
41 1.16 0.75-1.81 0.51
*
         (detail) - (-)
(54 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 668
(60%)
14 y
*

(detail)
94 (-)
( - )
(detail)
123 0.88 0.73-1.06 0.18 232 1.02 0.90-1.16 0.74 Japanese
72 (4)
(65 - 79)
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, DM, O, SCH, SM, SH‡ Ninomiya, 2011
Ninomiya, 2011 Hisayama Study Incidence study reporting hazard ratios (HRs) 534
(61%)
28 y
*

(detail)
79 (-)
( - )
(detail)
123 1.12 0.93-1.34 0.25 232 1.20 1.05-1.36 0.008 Japanese
57 (4)
( - )
Screening: HDS, HDS-R, MMSE

AD Diagnosis: Autopsy, Brain Imaging, NINDS-AIREN, NINCDS ADRDA
(detail)
A, E, G, ALC, AHD, BMI, DM, O, SCH, SM, SH‡ Ninomiya, 2011
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 6985
(60%)
2.1 y
(detail)
74 (12)
( - )
(detail)
124 0.94 0.82-1.09 0.39
*
196 0.89 0.79-1.00 0.05
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
Shah, 2006 ROS Incidence study reporting hazard ratios (HRs) 824
(69%)
6.0 y
*

(detail)
75 (17)
(38 - 93)
(detail)
151 1.00
*
0.86-1.16
*
0.98         Caucasian, Other
(detail)
75 (7)
( - )
AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Shah, 2006
Verghese, 2003 Bronx Aging Study Incidence study reporting hazard ratios (HRs) 406
(64%)
6.7 y
*

(detail)
85.6 (12)
( - )
(detail)
65 0.81
*
0.66-1.00
*
0.05
*
122 0.83
*
0.71-0.97
*
0.02
*
Caucasian
(detail)
79 (3)
(75 - 85)
(detail)
Screening: Blessed, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Verghese, 2003
Yang, 2011   Incidence study reporting hazard ratios (HRs) 594
(59%)
6.7 y
(detail)
77 (12)
( - )
(detail)
217 0.82
*
0.70-0.95
*
0.03         Caucasian, Other, African-American (Black)
76 (9)
( - )
Screening: CDR, Informant interview, Other

AD Diagnosis: DSM IIIR, NINCDS ADRDA
(detail)
A, E, G, APOE234, RE‡
(detail)
Yang, 2011
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "ALC" (alcohol intake), "AHD" (antihypertensive drug use), "APOE234" (APOE e2 e3 e4 genotype), "BMI" (body mass index), "DM" (diabetes mellitus), "IDD" (interval to disease diagnosis), "O" (other), "RE" (race/ethnicity), "SCH" (serum cholesterol), "SM" (smoking status), "SS" (stratified sampling), "SH" (stroke history), "SP" (study population)
 
Table 12:   Systolic blood pressure - untreated - continuous, per 10 mm Hg increase
Notes The report in this table evaluates the relationship between AD risk and systolic blood pressure (SBP), considered as a continuous variable, among those who were not medically treated for hypertension. Criteria for being classified as “treated” or “untreated” vary from study to study (e.g., baseline or ever), and we have included these definitions in the detail text. This report assumes an exponential (i.e., log-linear) relationship between SBP and AD risk. We report findings over a uniform interval of SBP (effect size per 10-mm Hg increment in SBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 4687
(60%)
2.1 y
(detail)
140.3 (23)
( - )
(detail)
- 1.02 0.92-1.14 0.72
*
- 1.00 0.92-1.09 1.0
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
* Derived value.
‡ Covariates: "A" (age), "G" (gender), "SP" (study population)
 
Table 13:   Systolic blood pressure - treated - continuous, per 10 mm Hg increase
Notes The report in this table evaluates the relationship between AD risk and systolic blood pressure (SBP), considered as a continuous variable, among those who were medically treated for hypertension. Criteria for being classified as “treated” or “untreated” vary from study to study (e.g., baseline or ever), and we have included these definitions in the detail text. This report assumes an exponential (i.e., log-linear) relationship between SBP and AD risk. We report findings over a uniform interval of SBP (effect size per 10-mm Hg increment in SBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 2298
(60%)
2.1 y
(detail)
140.3 (23)
( - )
(detail)
- 0.91 0.81-1.02 0.11
*
- 0.86 0.78-0.95 0.003
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
* Derived value.
‡ Covariates: "A" (age), "G" (gender), "SP" (study population)
 
Table 14:   Diastolic blood pressure - untreated - continuous, per 10 mm Hg increase
Notes The report in this table evaluates the relationship between AD risk and diastolic blood pressure (DBP), considered as a continuous variable, among those who were not medically treated for hypertension. Criteria for being classified as “treated” or “untreated” vary from study to study (e.g., baseline or ever), and we have included these definitions in the detail text. This report assumes an exponential (i.e., log-linear) relationship between DBP and AD risk. We report findings over a uniform interval of DBP (effect size per 10-mm Hg increment in DBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 4687
(60%)
2.1 y
(detail)
74 (12)
( - )
(detail)
- 0.97 0.79-1.18 0.77
*
- 0.95 0.82-1.12 0.52
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
* Derived value.
‡ Covariates: "A" (age), "G" (gender), "SP" (study population)
 
Table 15:   Diastolic blood pressure - treated - continuous, per 10 mm Hg increase
Notes The report in this table evaluates the relationship between AD risk and diastolic blood pressure (DBP), considered as a continuous variable, among those who were medically treated for hypertension. Criteria for being classified as “treated” or “untreated” vary from study to study (e.g., baseline or ever), and we have included these definitions in the detail text. This report assumes an exponential (i.e., log-linear) relationship between DBP and AD risk. We report findings over a uniform interval of DBP (effect size per 10-mm Hg increment in DBP), which required us to convert some results to fit this interval.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Ruitenberg, 2001 RS/GH-70 Combo Incidence study reporting hazard ratios (HRs) 2298
(60%)
2.1 y
(detail)
74 (12)
( - )
(detail)
- 0.93 0.74-1.16 0.53
*
- 0.82 0.68-0.98 0.03
*
 (detail) 70 (9)
(55 - )
Screening: CAMDEX, GMS, MMSE, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, G, SP‡
(detail)
Ruitenberg, 2001
* Derived value.
‡ Covariates: "A" (age), "G" (gender), "SP" (study population)
 
Table 16:   Pulse pressure - continuous, per 10 mm Hg increase
Notes Pulse pressure is defined as systolic blood pressure minus diastolic blood pressure. High pulse pressure indicates the presence of atherosclerosis and arterial stiffness, and typically, pulse pressure increases with age. The results in this table are from evaluations of AD risk along the continuum of pulse pressure, assuming an exponential (i.e. log-linear) relationship between the two.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Morris, 2001 East Boston EPESE Cumulative incidence study reporting odds ratios (ORs) 634
(63%)
4.5 y
(detail)
- (-)
( - )
(detail)
99 0.85 0.70-1.02 0.09
*
         (detail) 72 (-)
(65 - )
(detail)
AD Diagnosis: Modified NINCDS ADRDA
(detail)
A, E, G, IDD, SS‡
(detail)
Morris, 2001
Qiu, 2003b Kungsholmen Project Incidence study reporting hazard ratios (HRs) 1270
(75%)
4.3 y
*

(detail)
74.5 (8)
( - )
(detail)
256 1.06 0.99-1.13 0.08
*
339 1.05 0.99-1.11 0.09
*
 (detail) 82 (5)
(75 - )
(detail)
AD Diagnosis: Other
(detail)
A, E, G, AHD, APOE234, MMSE, DBP, PR, VD‡
(detail)
Qiu, 2003b
Yang, 2011   Incidence study reporting hazard ratios (HRs) 594
(59%)
6.7 y
(detail)
65.6 (19)
( - )
(detail)
217 1.00
*
0.90-1.11
*
0.92         Caucasian, Other, African-American (Black)
76 (9)
( - )
Screening: CDR, Informant interview, Other

AD Diagnosis: DSM IIIR, NINCDS ADRDA
(detail)
A, E, G, APOE234, RE‡
(detail)
Yang, 2011
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "AHD" (antihypertensive drug use), "APOE234" (APOE e2 e3 e4 genotype), "MMSE" (baseline MMSE), "DBP" (diastolic blood pressure), "IDD" (interval to disease diagnosis), "PR" (pulse rate), "RE" (race/ethnicity), "SS" (stratified sampling), "VD" (vascular disease)
 
Table 17:   Mean arterial pressure - continuous, per 10 mm Hg increase
Notes Conceptually, mean arterial pressure (MAP) is the average pressure in an artery over a single cardiac cycle (i.e., one heartbeat) but it often calculated from measurements of systolic and diastolic blood pressure. The report in this table evaluates the relationship between AD risk and MAP, considered as a continuous variable. Such reports assume an exponential (i.e., log-linear) relationship between MAP and AD risk. We report findings over a uniform interval of MAP (effect size per 10-mm Hg increment in MAP).  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)
Average Follow-up Time mm Hg
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)
Diagnostic Assessment Covariates & Analysis Comment Paper
Verghese, 2003 Bronx Aging Study Incidence study reporting hazard ratios (HRs) 406
(64%)
6.7 y
*

(detail)
108.2 (14)
( - )
(detail)
65 0.83
*
0.70-1.00
*
0.05
*
122 0.86
*
0.76-0.98
*
0.02
*
Caucasian
(detail)
79 (3)
(75 - 85)
(detail)
Screening: Blessed, Other

AD Diagnosis: NINCDS ADRDA
(detail)
A, E, G‡
(detail)
Verghese, 2003
Yang, 2011   Incidence study reporting hazard ratios (HRs) 594
(59%)
6.7 y
(detail)
98.8 (13)
( - )
(detail)
217 0.90
*
0.82-1.00
*
0.06         Caucasian, Other, African-American (Black)
76 (9)
( - )
Screening: CDR, Informant interview, Other

AD Diagnosis: DSM IIIR, NINCDS ADRDA
(detail)
A, E, G, APOE234, RE‡
(detail)
Yang, 2011
* Derived value.
‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE234" (APOE e2 e3 e4 genotype), "RE" (race/ethnicity)