Supplemental Digital Content is available in the text. High blood pressure (BP) negatively affects brain structure and function. Hypertension is associated with white matter hyperintensities, cognitive and mobility impairment in late-life. However, the impact of BP exposure from young adulthood on brain structure and function in mid-life is unclear. Identifying early brain structural changes associated with BP exposure, before clinical onset of cognitive dysfunction and mobility impairment, is essential for understanding mechanisms and developing interventions. We examined the effect of cumulative BP exposure from young adulthood on brain structure in a substudy of 144 (61 female) individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study. At year 30 (Y30, ninth visit), participants (56±4 years old) completed brain magnetic resonance imaging and gait measures (pace, rhythm, and postural control). Cumulative systolic and diastolic BP (cumulative systolic blood pressure, cDBP) over 9 visits were calculated, multiplying mean values between 2 consecutive visits by years between visits. Surface-based analysis of basal ganglia and thalamus was achieved using FreeSurfer-initiated Large Deformation Diffeomorphic Metric Mapping. Morphometric changes were regressed onto cumulative BP to localize regions of shape variation. Y30 white matter hyperintensity volumes were small and positively correlated with cumulative BP but not gait. Negative morphometric associations with cumulative systolic blood pressure were seen in the caudate, putamen, nucleus accumbens, pallidum, and thalamus. A concave right medial putamen shape mediated the relationship between cumulative systolic blood pressure and stride width. Basal ganglia and thalamic morphometric changes, rather than volumes, may be earlier manifestation of gray matter structural signatures of BP exposure that impact midlife gait.

中文翻译：

---

中年累积血压暴露、基底神经节和丘脑形态学

补充数字内容在文本中可用。高血压 (BP) 会对大脑结构和功能产生负面影响。高血压与晚年的白质高信号、认知和活动障碍有关。然而，年轻时接触 BP 对中年大脑结构和功能的影响尚不清楚。在认知功能障碍和运动障碍临床发作之前识别与血压暴露相关的早期大脑结构变化，对于理解机制和开发干预措施至关重要。我们在来自 CARDIA（年轻成人冠状动脉风险发展）研究的 144 名（61 名女性）个体的子研究中检查了年轻成年期累积 BP 暴露对大脑结构的影响。在第 30 年（Y30，第九次访问），参与者（56±4 岁）完成了脑磁共振成像和步态测量（步伐、节奏和姿势控制）。计算了 9 次访问的累积收缩压和舒张压（累积收缩压，cDBP），将两次连续访问之间的平均值乘以访问之间的年数。基底神经节和丘脑的基于表面的分析是使用 FreeSurfer 启动的大变形微分度量映射实现的。形态学变化被回归到累积 BP 以定位形状变化的区域。Y30 白质高信号体积很小，与累积血压呈正相关，但与步态无关。在尾状核、壳核、伏隔核、苍白球和丘脑中观察到与累积收缩压呈负形态测量关联。凹入的右侧内侧壳核形状介导了累积收缩压和步幅之间的关系。基底神经节和丘脑形态学变化，而不是体积，可能是影响中年步态的 BP 暴露灰质结构特征的早期表现。