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Reader response: Blood pressure from mid- to late life and risk of incident dementia

We read with interest the article by McGrath et al.,1 which reported a significant association between elevated mid-life blood pressure (BP), persistent late-life BP, steep mid-to-late life BP decline, and risk of dementia, and underscored the vascular contribution to cognitive dysfunction. The exact role of vascular disease in the pathophysiology of Alzheimer disease (AD) and non-AD dementias remains unclear. The analysis of reliable hemodynamic measures besides BP trajectories, like the pulsatile component of BP through pulse pressure,2 and the BP variability through average real variability,3–5 which accounts for the order of BP measurements over time, or residual SD, which takes account of temporal trends in BP, may be advisable. These measures could provide a more nuanced perspective of the mechanisms linking vascular aging to neurodegeneration, and add useful insights toward potential future therapeutic horizons.

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