Aging & Longevity

Sex differences in the association of late-life blood pressure decline with postmortem brain vessel pathology.

Baumgartner N, Du L, et al. • Acta neuropathologica • 2026

PubMed 42925335 DOI 10.1007/s00401-026-03107-1

TL;DR

This longitudinal clinical-pathologic study of older decedents showed sex differences in the association of declining SBP in late-life with severity of arteriolosclerosis, extending prior associations with cognitive decline to cerebrovascular pathology.

Key Findings

Results

Faster late-life systolic blood pressure (SBP) decline was associated with greater severity of postmortem arteriolosclerosis.

OR = 1.24, 95% CI 1.08-1.42 from ordinal regression.
Models were adjusted for age-at-death, sex, antihypertensive medication use, and BP slope × sex, age-at-death × sex, and BP slope × age-at-death interactions.
Sample was 2033 community-dwelling older adults from four longitudinal cohort studies with brain autopsy.

Results

Faster late-life SBP decline was associated with greater severity of postmortem atherosclerosis.

OR = 1.41, 95% CI 1.22-1.63 from ordinal regression.
Person-specific SBP slopes were estimated from annual clinical evaluations over an average of 9.1 (SD 5.7) years.

Results

The association between SBP decline and arteriolosclerosis severity differed by sex, being stronger in women than in men.

A sex × SBP slope interaction was significant (p = 0.01).
The cohort was 69% women.
The authors note this extends their prior finding of sex-specific associations between declining SBP and cognitive decline.

Background

The study examined the relation of late-life BP change to three types of cerebrovascular pathology (arteriolosclerosis, atherosclerosis, and cerebral amyloid angiopathy) beyond brain infarcts, with sex differences as a focus.

Participants had mean baseline age 79.7 (SD 7.1) years and mean age-at-death 89.8 (SD 6.6) years.
Data came from four longitudinal cohort studies with brain autopsy.
Prior postmortem studies had not examined whether BP change differentially relates to vascular brain pathology in men and women.

Conclusions

The authors conclude that longitudinal BP monitoring may have potential for precision medicine approaches to cerebrovascular disease risk stratification.

Findings extend prior associations between SBP decline and cognitive decline to cerebrovascular pathology.
The authors suggest cerebrovascular pathology may be an upstream contributor to sex differences in BP-related cognitive decline.

What This Means

This study looked at whether changes in blood pressure in older age are linked to damage in the brain's blood vessels found after death. It used data from 2033 older adults (69% women) who were followed with yearly check-ups for about 9 years on average and who donated their brains for autopsy at an average age of about 90. People whose systolic blood pressure (the top number) fell faster in late life tended to have more severe small-vessel disease (arteriolosclerosis) and more severe hardening of larger brain arteries (atherosclerosis). The link between falling systolic blood pressure and small-vessel disease was stronger in women than in men. These results account for age at death, sex, and use of blood pressure medicines. This research suggests that tracking how blood pressure changes over time, not just single readings, might help identify people at higher risk of brain vessel disease, and that risk patterns may differ between men and women. Because the study looked at people after death and shows association rather than cause, it cannot say whether the blood pressure decline causes the vessel damage or is a sign of it.

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Citation

Baumgartner N, Du L, Mehta R, Casaletto K, Wood Alexander M, Rabin J, et al.. (2026). Sex differences in the association of late-life blood pressure decline with postmortem brain vessel pathology.. Acta neuropathologica. https://doi.org/10.1007/s00401-026-03107-1

Key Findings

What This Means

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