The role of blood pressure and hypertension in dementia

Hypertension represents a highly prevalent and modifiable risk factor that has been consistently associated with neurodegenerative brain changes and cognitive decline in human and animal studies. Midlife elevations in blood pressure appear to be most strongly associated with late-life cognitive impairment, dementia, and structural brain abnormalities. It is less clear how late-life blood pressure relates to dementia, as some, but not all, studies show protective effects of elevated blood pressure during late life. Although few studies have tested this hypothesis directly, there is some indication that persons with hypertension during midlife who then go on to have low blood pressure levels as older adults have especially poor neurocognitive outcomes. Several pathways have been identified through which elevated blood pressure is thought to adversely affect brain health in general and promote Alzheimer’s disease more specifically. Such findings have led to the development of randomized clinical trials to test the neuroprotective effects of antihypertensive agents.