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Manage Hypertension, Prevent Dementia?

Manage Hypertension, Prevent Dementia?

The CDC estimates than 75 million adults in America have high blood pressure—also called hypertension—and only half have it under control [1]. This is worrying for reasons that go beyond the brain. Extensive evidence shows that managing hypertension is very likely to improve long-term brain health and lower dementia risk [2][3].

In people with hypertension, blood pushes aggressively against artery walls, forcing the heart to work harder. Over time, this can cause arteries to spasm, stiffen, or harden, which impairs brain function [4]. Hypertension increases the risk of stroke and ministroke, and it's associated with brain shrinkage [5]. Studies suggest that having hypertension in middle age increases the risk of both vascular dementia [6] and Alzheimer's disease [2]. Even in later years, keeping hypertension under control may protect against cognitive decline [7]. An analysis of several studies found that people who managed their hypertension had a nine percent lower risk of dementia and higher cognitive function overall [8].

The risk of dementia and cognitive decline in unmanaged hypertension is even higher in those with an APOE4 gene [9-13]. Two observational studies have suggested that managing hypertension may be particularly protective for APOE4 carriers [9][14], but more research is needed to confirm this as the studies focused on anti-hypertensive drugs and didn’t include other management strategies [15].

Hypertension can be managed through diet, lifestyle changes, and medications. The DASH and Mediterranean diets have strong evidence of long-term health and cognitive benefits. Lifestyle modifications such as achieving and maintaining a healthy weight, moderating alcohol consumption, exercising regularly, and avoiding cigarettes can improve hypertension [16].

Several types of medications are available that can successfully treat hypertension. Research is ongoing to determine whether the choice of one drug versus another offers particular protection from dementia and cognitive decline [8][17-19]. Other clinical trials are underway—several with support from the Alzheimer's Drug Discovery Foundation—to test whether certain antihypertensive drugs may be able to treat Alzheimer's disease and vascular dementia in patients without hypertension [20–22].

If you do have hypertension, consult a doctor and manage it as carefully as possible. The earlier you get it under control, the more you will protect your brain.


  1. High Blood Pressure Fact Sheet [Internet]. Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention; 2016 [cited 2016Oct17].
  2. Roman, G.C., D.T. Nash, and H. Fillit, Translating current knowledge into dementia prevention. Alzheimer Dis Assoc Disord, 2012. 26(4): p. 295-9.
  3. Deckers, K., et al., Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry, 2015. 30(3): p. 234-46.
  4. Sato, N. and R. Morishita, Roles of vascular and metabolic components in cognitive dysfunction of Alzheimer disease: short- and long-term modification by non-genetic risk factors. Front Aging Neurosci, 2013. 5: p. 64.
  5. Firbank, M.J., et al., Brain atrophy and white matter hyperintensity change in older adults and relationship to blood pressure. Brain atrophy, WMH change and blood pressure. J Neurol, 2007. 254(6): p. 713-21.
  6. Di Bari, M., et al., Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial. Am J Epidemiol, 2001. 153(1): p. 72-8.
  7. Parsons, C., et al., The effect of antihypertensive treatment on the incidence of stroke and cognitive decline in the elderly: a meta-analysis. Future Cardiol, 2016. 12(2): p. 237-48.
  8. Levi Marpillat, N., et al., Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens, 2013. 31(6): p. 1073-82.
  9. Rodrigue, K.M., et al., Risk factors for beta-amyloid deposition in healthy aging: vascular and genetic effects. JAMA Neurol, 2013. 70(5): p. 600-6.
  10. Bangen, K.J., et al., APOE Genotype Modifies the Relationship between Midlife Vascular Risk Factors and Later Cognitive Decline. J Stroke Cerebrovasc Dis, 2013. 22(8): p. 1361-9.
  11. de Frias, C.M., K.W. Schaie, and S.L. Willis, Hypertension moderates the effect of APOE on 21-year cognitive trajectories. Psychol Aging, 2014. 29(2): p. 431-9.
  12. Yasuno, F., et al., Effect of plasma lipids, hypertension and APOE genotype on cognitive decline. Neurobiol Aging, 2012. 33(11): p. 2633-40.
  13. Qiu, C., et al., Combined effects of APOE genotype, blood pressure, and antihypertensive drug use on incident AD. Neurology, 2003. 61(5): p. 655-60.
  14. Guo, Z., et al., Apolipoprotein E genotypes and the incidence of Alzheimer's disease among persons aged 75 years and older: variation by use of antihypertensive medication? Am J Epidemiol, 2001. 153(3): p. 225-31.
  15. Etnier, J.L., et al., Innovative Research Design Exploring the Effects of Physical Activity and Genetics on Cognitive Performance in Community-Based Older Adults. J Aging Phys Act, 2015. 23(4): p. 559-68.
  16. Mancia, G. and G. Grassi, Management of essential hypertension. Br Med Bull, 2010. 94: p. 189-99.
  17. Fournier, A., et al., Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors. Expert Rev Neurother, 2009. 9(9): p. 1413-31.
  18. Tully, P.J., et al., Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies. J Hypertens, 2016. 34(6): p. 1027-35.
  19. Dacks, P.A., et al., A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline. Alzheimers Res Ther, 2016. 8(1): p. 33.
  20. Lawlor, B., A Phase III Trial of Nilvadipine to Treat Alzheimer's Disease (NILVAD); NCT02017340, in ClinicalTrials.gov. 2013, U.S. Naitonal Institutes of Health.
  21. Lawlor, B., et al., NILVAD protocol: a European multicentre double-blind placebo-controlled trial of nilvadipine in mild-to-moderate Alzheimer's disease. BMJ Open, 2014. 4(10): p. e006364.
  22. Black, S.E., Telmisartan vs. Perindopril in Hypertensive Mild-Moderate Alzheimer's Disease Patients (SARTAN-AD); NCT02085265, in ClinicalTrials.gov. 2013, U.S. National Institutes of Health.

Dr. Penny Dacks was previously the Director of Aging and Alzheimer’s Disease Prevention at the Alzheimer's Drug Discovery Foundation. She was trained in neuroscience at the Mount Sinai School of Medicine, the University of Arizona, and Queen's University (Canada) with individual fellowships from the National Institute of Health, the Evelyn F. McKnight Brain Research Foundation, the ARCS Foundation and the Hilda and Preston Davis Foundation. She has authored over 18 peer-reviewed scientific articles and is a member of the Society for Neuroscience, the Gerontological Society of America, the Endocrine Society and the Association for Women in Science.

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