New research confirms that keeping blood pressure in check could help lower cognitive decline risk as we age.
- Intensive blood pressure control for adults with hypertension and
high cardiovascular risk can reduce the risk of mild cognitive impairment
or dementia in the long term, according to a new study.
- Current estimates suggest that more than 9 million Americans could
have dementia by 2030, and nearly 12 million by 2040. Mild cognitive
impairment, a transitional state between normal cognitive aging and
dementia, is also expected to increase.
- Uncontrolled high blood pressure can result in a greater risk for
cognitive decline or dementia as well as cardiovascular disease.
- More than half of all Americans experience hypertension by the time
they are 50.
Intensive blood pressure
control for adults with hypertension (high blood
pressure) and high cardiovascular risk can reduce the risk of
mild cognitive impairment or dementia in
the long term, according to a new study by researchers at Wake Forest
University School of Medicine.
This is in the context
in which more than 9 million Americans could develop dementia by
2030, and nearly 12 million by 2040. DataTrusted Source also suggest that more than
half of all Americans experience hypertension by the time they are 50.
The recent study,
published in Neurology, aimed to examine the effects on cognitive
decline from standard and intensive blood pressure treatment.
Blood
pressure and brain health risks
Researchers used data
from the landmark Systolic Blood Pressure Intervention TrialTrusted Source,
or SPRINT, which compared intensive treatment to standard treatment of systolic blood pressureTrusted Source among
people with hypertension, and had results published in 2015.
The findings suggested
that lowering systolic blood pressure would reduce the risk of dementia, but
the SPRINT study’s success in lowering cardiovascular disease meant that it was
stopped early, so ultimate results regarding dementia were inconclusive.
The new study’s authors
aimed to sustain the process of intensive blood pressure treatment for more
conclusive results.
SPRINT’s researchers
incorporated 9,361 patients over the age of 50 in the United States and Puerto
Rico, who were randomly assigned to a systolic blood pressure goal of either
less than 120 millimeters of mercury (mm Hg), which amounted to an intensive
treatment, or less than 140 mm Hg (standard treatment) between 2010 and 2013.
The patients received
3.3 years of treatment and were followed up with until 2018.
The new study’s
researchers determined the cognitive status of 4,232 (59%) participants (mean
age 67 years, 36% female).
During the years of
follow-up, 248 of those who had undergone intensive blood pressure treatment
were determined to have probable dementia or mild cognitive impairment,
compared with 293 participants who had received standard treatment.
The findings confirmed
that an intensive treatment of hypertension was associated with a significantly
lower risk of mild cognitive decline.
“Over a median of almost
7 years of follow-up, we observed that the previously reported statistically
significant reduction in the rate of cognitive impairment (composite of [mild
cognitive decline] or probable dementia) was maintained,” the researchers write
in their study paper.
“The estimated effect on
probable dementia, although not statistically significant, was also similar to
the primary trial analysis in showing a lower incidence of probable dementia
associated with intensive treatment,” they further note.
How
does blood pressure affect cognition and dementia?
American Heart
Association data indicate that almost halfTrusted Source of
adults in the United States have high blood pressure, and most of them are not
adequately managing this condition.
Research published in 2022 showed
that the longer a person’s blood pressure remains under control, the lower
their risk for cognitive decline or dementia.
José Morales, MD, a vascular neurologist and
neurointerventional surgeon at Providence Saint John’s Health Center in Santa
Monica, CA, who was not involved in the study, told Medical News
Today that, left unchecked, high blood pressure can leave damage
beyond cardiovascular impairments:
“Elevated
blood pressure leads to end-organ damage in the brain. While it is more
commonly associated with stroke, its insidious effects are cognitive
impairment. There are likely subclinical changes that are undetectable or
unnoticeable due to cognitive reserve, but the degree or extent of brain damage
that results in cognitive impairment is most likely many years in the making
and insidiously progressing.”
What
are the best treatments for high blood pressure?
The study focused on
treatment involving medication rather than any lifestyle changes. Doctors will
often recommend a low dose of medication at first, but people with hypertension
may need to combine two or moreTrusted Source drugs to manage their blood
pressure, depending on the person and any underlying medical conditions they
may have.
Medications for hypertension include:
- diuretics,
including thiazides, chlorthalidone, and indapamide
- beta-blockers and
alpha-blockers
- calcium-channel
blockers
- central agonists
- peripheral adrenergic inhibitors
- vasodilators
- angiotensin-converting
enzyme (ACE) inhibitors
- angiotensin receptor blockers.
“Lifestyle and dietary
changes are definitely first line approaches, but when these fail to adequately
control hypertension medication becomes necessary,” said Morales.
“It really depends
patient to patient. Some patients are young and have poorly controlled blood
pressure, which is likely causing subclinical damage that increases their later
life risk of dementia. In general, the average person with hypertension is
middle-aged and studies now implicate this age bracket with significant changes
in our body that are a harbinger for future health,” he explained.
Cheng-Han
Chen, MD, a board-certified interventional cardiologist and medical
director of the Structural Heart Program at MemorialCare Saddleback Medical
Center in Laguna Hills, CA, who also was not involved in the study, told MNT that
high blood pressure, if left unchecked, does damage to cognition over years,
regardless of age.
However, adults in
middle age generally are the most at risk if their blood pressure is beyond
normal range.
“There is a not a single
age at which high blood pressure permanently leads to cognitive decline.
Rather, the negative effects of high blood pressure likely occur over a period
of decades,” Chen said.
“Some studies point to
‘midlife‘ (age 40’s to early 60’s) as the period of life during which much of
the damage occurs,” he noted, which emphasizes the importance of managing blood
pressure as we age.
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