Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

Abstract

Background Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. Methods Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. Results Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. Conclusions After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.

Oxidative Stress, Inflammation, and Vascular Aging in Hypertension

“…This is especially important in conditions associated with small vessel disease of the brain and cognitive impairment-a key clinical consequence of vascular aging. This prompted Hypertension to publish a key statement, 92 on the difference between vascular dementia and Alzheimer disease and articles on the impact of hypertension on exacerbating Alzheimer disease through reduced NO bioavailability and eNOS and nNOS activity. 93 Importantly, microvascular dysfunction leading to cognitive impairment is dependent on Nox2 activation in macrophages infiltrating perivascular space in the brain.…”

Fasting blood glucose level and its association with sex, body mass index and blood pressure: a cross sectional study on a Bangladeshi public university students

“…14 The result showed that 17.5% of the study subjects were hypertensive. It was observed that the blood glucose (mean±SE) level of hypertensive subjects (4.81±0.07mmol/L) were higher than that of the Department-wise distribution of hypertensive subjects and fasting blood glucose levels Table 2 shows the distribution of hypertensive subjects were compared dividing the study subjects in 15 departments.…”

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

“…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].…”

“…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]. Treatment of hypertension may help prevent or slow down the development of vascular brain lesions and improve cognitive performance in hypertensives [16,17].…”

“…Vascular aging is acknowledged as the major pathophysiology for age-related hypertension [11]; however, the mechanisms by which vascular aging leads to cognitive dysfunction in midlife remain poorly understood. Full elucidation of the mechanisms by which the pulsatile hemodynamics may affect the development of cognitive dysfunction starting at a young age is crucial to safeguard vascular health and brain health in midlife [12]. …”