Blood Pressure and Vascular Cognitive Impairment

Abstract

High blood pressure (BP) is detrimental to brain health. High BP contributes to cognitive impairment and dementia through pathways independent of clinical stroke. Emerging evidence shows that the deleterious effect of high BP on cognition occurs across the life span, increasing the risk for early-onset and late-life dementia. The term vascular cognitive impairment includes cognitive disorders associated with cerebrovascular disease, regardless of the pathogenesis. This focused report is a narrative review that aims to summarize the epidemiology of BP and vascular cognitive impairment, including differences by sex, race, and ethnicity, as well as the management and reversibility of BP and vascular cognitive impairment. It also discusses knowledge gaps and future directions.

Night blood pressure variability, brain atrophy, and cognitive decline

“…In our study, total brain volume atrophy and cognitive decline were associated with increased night BPV, but not with night mean BP. It is well-known that high BP contributes to cognitive impairments and dementia ( 3 , 28 ). However, despite excellent BP control in a post-hoc analysis of the SPRINT MIND trial, higher BPV was associated with an increased risk of dementia ( 29 ), suggesting that increased BPV might be an independent factor associated with brain damage.…”

“…This study included 1,967 subjects who examined 24-h ABPM during the baseline period (2011–2014) ( Figure 1 ). We excluded 224 subjects with the following conditions: ( 1 ) valid 24-h ABPM ≤ 70% of the readings of total 24-h BP measurements ( n = 202); ( 2 ) cerebrovascular disease ( n = 10); and ( 3 ) any cancer ( n = 12). Among the remaining 1,743 subjects, 1,438 individuals underwent both baseline and follow-up brain MRI scans.…”

“…KoGES participants were administered the neuropsychological assessment battery described below during the regular examination cycle as part of the baseline measurement of the aging study: ( 1 ) story recall test, immediate and delayed recall, and recognition; ( 2 ) visual reproduction, immediate and delayed recall, and recognition; ( 3 ) verbal fluency; ( 4 ) trail making tests; ( 5 ) Digit Symbol-coding, incidental learning, and free recall; and ( 6 ) Korean-Color Word Stroop Test, word reading, and color reading. Standard administration protocols were used for each testing session, and the tests were conducted by well-trained and experienced psychological examiners.…”

“…High blood pressure (BP) has been shown to be associated with brain atrophy and cognitive dysfunctions ( 1 – 3 ). Nocturnal hypertension showed significant associations with brain volume and cognitive impairment ( 1 , 4 , 5 ).…”

Meningeal IL-17 producing T cells mediate cognitive impairment in salt-sensitive hypertension

“…Hypertension (HTN) is a major cause of death and disability worldwide, and a leading risk factor for dementia 1 . Although there have been significant advances in the pharmacotherapy, a sizable proportion of patients have uncontrolled or resistant HTN which is particularly damaging to the brain 2, 3 .…”