Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review

Walker, Keenan A.; Power, Melinda C.; Gottesman, Rebecca F.

doi:10.1007/s11906-017-0724-3

Cited by 322 publications

(301 citation statements)

References 210 publications

(186 reference statements)

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“…However, recent findings suggest that the association between BP and brain health is complex and dependent on factors such as age, chronic hypertension, and antihypertensive medication use [21]. Indeed, inverse associations of BP have been reported in prior studies [11, 12, 22–25].…”

Section: Discussionmentioning

confidence: 99%

Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

et al. 2017

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BackgroundA lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment.MethodsIn Nord-Trøndelag County, Norway, incident dementia data were collected during 1995–2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects’ personal identification numbers, the dementia data were linked to data from the Nord-Trøndelag Health Study (the HUNT Study), a large, population-based health study performed in 1984–1986 (HUNT 1) and 1995–1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2.ResultsOver the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years.ConclusionsOur data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in individuals over the age of 60 years. We cannot exclude a survival effect, however. Among middle-aged subjects (<60 years), elevated systolic blood pressure and pulse pressure were associated with eventual Alzheimer disease in individuals who reported using antihypertensive medication.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0262-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

et al. 2017

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“…The decrease in HDL-C after middle age was strongly associated with the considerable increase in dementia in late-life. It has been well known that controlling BP in the normal range is an effective strategy for the prevention of primary and secondary dementia [14]. However, there has been no study to elucidate the correlation and regression between blood pressure and the HDL-C level in the adult population.In the current study, we investigated the cross-sectional relationship between BP and serum HDL-C in the free-living Korean population because there has been no report of the correlation between HDL-C level and SBP or DBP.…”

mentioning

confidence: 99%

Decrease in Serum HDL-C Level Is Associated with Elevation of Blood Pressure: Correlation Analysis from the Korean National Health and Nutrition Examination Survey 2017

Cho

Park

Kim

2020

IJERPH

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A low-serum, high-density lipoproteins-cholesterol (HDL-C) level and high blood pressure (BP) are independent risk factors for cardiovascular disease and dementia. In the present study, in order to find putative correlation between low HDL-C and hypertension, 4552 subjects (20-80 years old) were selected from the Korean National Health And Nutrition Examination Survey 2017 (KNHANES VII-2, n = 2017 men, n = 2535 women). They were classified into four levels of blood pressure, ranging from BP1 (normal, below 120/80 mmHg for systolic BP (SBP)/diastolic BP (DBP), BP2 (prehypertension, 120/80 to 139/89 mmHg), BP3 (hypertension stage 1, 140/90-159/99 mmHg), and BP4 (hypertension stage 2, higher than 160/100 mmHg). Generally, in the total population, a higher SBP level and age were associated with a lower HDL-C in both genders. However, DBP was not associated with age in men. In the total population, Pearson's correlation analysis revealed that SBP (r = −0.188, p < 0.001) and DBP (r = −0.198, p < 0.001) showed negative correlations with percentage of HDL-C in total cholesterol (TC), HDL-C/TC (%). In both genders, HDL-C gradually decreased with age and HDL-C/TC (%) was more accurate in expressing a correlation with BP. Women showed a more distinct decrease in HDL-C with an elevation of BP and age than men. Both elevation of DBP and SBP were associated with a decrease in HDL-C, around 2.3-2.4 mg/dL, between normal range and hypertension 2 stage. Additionally, DBP was significantly associated with HDL-C/TC (%) (men: r = −0.136, p < 0.001; women: r = −0.152, p < 0.001), while HDL-C did not show a significant association with a change in DBP. In conclusion, SBP was positively correlated with age, but DBP did not change significantly with age. The correlation of BP and HDL-C depending on age showed that SBP gradually increased and HDL-C decreased with an increase in age. The percentage of HDL-C in TC was more significantly associated with a change in SBP and DBP in both genders. high total cholesterol (TC) and low high-density lipoproteins-cholesterol (HDL-C) are also independent risk factors of cardiovascular disease and cerebrovascular disease [5]. However, there has been no correlation analysis between change in blood pressure and HDL-C in general population.Hypertension in midlife is also a strong and independent risk factor of Alzheimer's disease and vascular dementia in late-life [6,7], because individuals who develop hypertension earlier in life are likely to be exposed to the deleterious neurological effects of hypertension for many decades. The higher midlife BP was associated with incidence of dementia in late-life [6]. Interestingly, subjects with midlife hypertension and late-life hypotension had a 4.26-fold higher risk of dementia. Blood pressure control is very important to prevent not only cardiovascular disease but also incidence of cognitive impairment and dementia [8]. The positive association of TC and hypertension and inverse associations of HDL-C and future risk of hypertension are well established [9].As...

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“…Elevated BP level is associated with cognitive decline and increased risk of dementia [9,10,12,13,14]. It is clear that hypertension may disrupt the cerebral microvascular structure and function [12] and may also be associated with increased risk of ischemic damage of white matter regions critical for cognitive function [9,15].…”

Section: Hypertension and Cognitive Dysfunction In Midlifementioning

confidence: 99%

“…Early intervention or treatment for hypertension in middle age, even in the subclinical state, may be substantially beneficial, given the strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function [14,24]. In fact, even in prehypertensive (systolic BP >120 and <140 mm Hg or diastolic BP >80 and <90 mm Hg) middle-aged adults, an elevated systolic BP level was shown to be negatively associated with cognitive performance, including memory and executive function [8].…”

Section: Hypertension and Cognitive Dysfunction In Midlifementioning

confidence: 99%

Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain

Lin¹,

Cheng²,

Chuang

et al. 2017

Pulse

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Background: Vascular aging may cause cerebral microvascular damage and cognitive dysfunction. There is incremental evidence that consistently implicates arterial stiffness being involved in the manifestation of cognitive impairment in the elderly. However, few investigations have examined the relationship between arterial stiffness and cognitive impairment in midlife. Summary: Past studies inconsistently showed improved cognitive outcomes after antihypertensive therapy in elderly populations. Nevertheless, recent findings revealed that blood-pressure-lowering treatment in young adults might eliminate or halt the progression of the detrimental effects related to arterial stiffness, indicating that younger adults may have more favorable outcomes in cognition than their older counterparts if early intervention is conducted at the subclinical stage. Stiffening of the aorta may lead to an excessive flow pulsatility in the brain that may cause microvascular structural brain damage and worse cognitive performance. Recent investigations have suggested that arterial stiffness is likely to trigger initial silent brain damage, possibly preceding midlife, while the manifestation of cognitive decline and deterioration can be foreseen in the subsequent life span. Key Message: Despite the recent novel findings, definite conclusions on causality between vascular aging and cognitive dysfunction cannot be drawn at present. Further well-powered longitudinal studies with superior neuroimaging indicator, vascular mechanical biomarkers, and sensitive cognitive assessment tools that examine a broad range of age populations may help extend our understanding of the association between vascular aging and cognitive dysfunction throughout the life span.

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Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review

Cited by 322 publications

References 210 publications

Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

Decrease in Serum HDL-C Level Is Associated with Elevation of Blood Pressure: Correlation Analysis from the Korean National Health and Nutrition Examination Survey 2017

Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain

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