Cerebrovascular function in hypertension: Does high blood pressure make you old?

Abstract

The majority of individuals over an age of 60 have hypertension. Elevated blood pressure and older age are associated with very similar changes in brain structure and function. We review the parallel brain changes associated with increasing age and blood pressure. This review focuses on joint associations of aging and elevated blood pressure with neuropsychological function, regional cerebral blood flow responses to cognitive and metabolic challenges, white matter disruptions, grey matter volume, cortical thinning, and neurovascular coupling. Treatment of hypertension ameliorates many of these changes but fails to reverse them. Treatment of hypertension itself appears more successful with better initial brain function. We show evidence that sympathetic and renal influences known to increase blood pressure also impact brain integrity. Possible central mechanisms contributing to the course of hypertension and aging are then suggested. An emphasis is placed on psychologically relevant factors: stress, cardiovascular reactions to stress, and diet/obesity. The contribution of some of these factors to biological aging remains unclear and may provide a starting point for defining the independent and interacting effects of aging and increasing blood pressure on the brain.

Age‐related changes in cerebrovascular health and their effects on neural function and cognition: A comprehensive review

“…One of the most important exacerbating factors is the presence of hypertension, a condition that exists in the majority of individuals over age 60 (Fryar et al., 2017). In this special issue, Jennings et al (2021) present an extensive discussion of the interaction between hypertension and alterations to the cerebrovasculature. There is evidence that arterial stiffening precedes hypertension (Dernellis & Panaretou, 2005; Kaess et al., 2012; Liao et al., 1999; Najjar et al., 2008; Oh, 2018; Oh et al., 2017; Weisbrod et al., 2013).…”

“…Somewhat surprisingly, many classes of medications for hypertension work well at reducing blood pressure, but do not treat the factors that caused the hypertension to appear in the first place. Strikingly, there is little evidence that hypertension treatment improves cognitive performance (Iadecola et al., 2016; Jennings et al., 2021). A major theme of this review is that many types of age‐related cerebrovascular dysfunction begin early in life, and are therefore partially preventable or even reversible with appropriate lifestyle adjustments to diet/fasting and exercise (see Aghjayan et al., 2021; Stillman et al., 2021, in this issue; Dong et al., 2020).…”

Aging and cerebrovascular health: Structural, functional, cognitive, and methodological implications

“…Chronic stress and other factors, such as poor diet and a sedentary life, also contribute to the development of hypertension, which is highly prevalent among middle‐aged and older adults. Jennings et al (2021) review the strong associations between hypertension and the brain and cognitive disruptions that frequently occur with aging. These include volumetric changes in grey matter, white matter dysfunction, as well as blood flow and neuropsychological deficits.…”

Neurobiological Pathways Linking Acute Mental Stress to Impairments in Executive Function in Individuals with Coronary Artery Disease

“…Previous studies have shown neurophysiological links between psychological stress and cardiovascular disease risk [ 43 ]. For example, brain blood flow responses to cognitive challenges identify individuals predisposed to hypertension [ 44 ], and activation of the prefrontal cortex during stress influences heart rate variability [ 45 ].…”