Abstract 4369982: Hypertension-Associated Accelerated Brain Aging - An Analysis from the UK Biobank Cohort

Background: Hypertension is a major modifiable risk factor for cerebrovascular diseases, with early onset impacting brain health. However, the quantifiable neuroimaging features of hypertension-related brain aging remain understudied. The brain age gap, i.e., the difference between neuroimaging-predicted brain age and chronological age, is a novel biomarker for detecting premature cerebral aging processes. Objective: To evaluate the association between chronic hypertension and accelerated brain aging using neuroimaging data. Methods: The study population included participants from UK Biobank with complete neuroimaging data, comparing hypertensive individuals to normotensive controls. Brain age gap was calculated using Beheshti's correction method to eliminate age-dependent prediction errors. Multivariate linear regression models examined hypertension associations adjusted with cardiovascular and socioeconomic covariates. Results: The study comprised 37,123 participants with complete neuroimaging data (mean chronological age: 64.05 years, 53.2% females), of whom 12,870 (34.7%) were diagnosed with hypertension. Compared to normotensive controls, hypertensive participants demonstrated higher BMI (28.01 vs. 25.74 kg/m 2 ), elevated waist-to-hip ratio (0.89 vs. 0.84), and increased HbA1c levels (35.99 vs. 34.38 mmol/mol). After adjusting for cardiovascular and socioeconomic covariates, hypertensive participants exhibited a significant 0.69-year increase in brain age gap compared to normotensive controls (95% CI: 0.60-0.78, p<0.0001), demonstrating premature cerebrovascular structural changes. There were no significant interactions observed between sex and hypertension. Conclusions: This study highlights the associations between chronic hypertension and accelerated brain aging. The brain age gap is a quantifiable biomarker that could be used to inform targeted treatment and preventive interventions in hypertensive populations.