The CDC estimates than 75 million adults in America have high blood pressure—also called hypertension—and only half have it under control . 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 .
WHAT THE EVIDENCE SAYS
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 . Hypertension increases the risk of stroke and ministroke, and it's associated with brain shrinkage . Studies suggest that having hypertension in middle age increases the risk of both vascular dementia  and Alzheimer's disease . Even in later years, keeping hypertension under control may protect against cognitive decline . 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 .
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 , but more research is needed to confirm this as the studies focused on anti-hypertensive drugs and didn’t include other management strategies .
WHAT YOU CAN DO
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 .
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 [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.
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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