Association Between Age at Hypertension Diagnosis and Brain Health: A Population‐Based Cohort Study

BACKGROUND: Evidence regarding the impact of age at hypertension onset on brain atrophy, independent of hypertension duration, remains limited. This study investigated whether the association between hypertension and brain volume differs by age at hypertension diagnosis. METHODS: In a multicenter, community-based cohort study (initiated in 2006), 948 participants were included: 117 early-onset hypertensives (diagnosed ≤40 years), 354 late-onset hypertensives (diagnosed >40 years), and 477 non-hypertensive controls, matched through propensity score matching. Neuroimaging data have been collected since 2020 to assess brain volume. The associations between early-onset and late-onset hypertension with brain volume were evaluated using the voxel-wise and generalized linear models. RESULTS: Compared to controls, early-onset hypertension was associated with lower volumes of cerebral parenchyma (β = -0.302; 95% confidence interval [CI], -0.541 to -0.063) and gray matter (β = -0.338; 95% CI, -0.590 to -0.087). The frontal, occipital, and temporal lobes showed the most prominent volume loss. Compared to participants with late-onset hypertension, early-onset hypertensives exhibited more pronounced brain volume reductions, especially in the frontal lobe. In contrast, compared with the matched non-hypertensive controls, the pattern of brain volume reduction in the late-onset hypertension group was similar to that in the early-onset hypertension group at the voxel level but did not reach statistical significance after full adjustment for covariates. CONCLUSIONS: There is a significant correlation between early-onset hypertension and brain atrophy. It is crucial to manage blood pressure at a young age. For patients diagnosed with hypertension before the age of 40, it is recommended to strengthen brain health monitoring while undergoing antihypertensive treatment.