Physicians' Academy for Cardiovascular Education

AHA Scientific Statement scrutinises link between hypertension and dementia

Oct. 19, 2016 - news

A multidisciplinary panel of experts has written an AHA Scientific Statement on the impact of hypertension on cognitive function, since chronic arterial hypertension is a well-established risk factor for both vascular dementia and Alzheimer’s disease. The panel reviewed the available literature on the topic, since the link between hypertension and its treatment and cognitive decline remains poorly understood. While data are insufficient to formulate evidence-based recommendations, the panel advocates ‘judicious’ treatment of hypertension, as this likely safeguards vascular health, and as a consequence, brain health.
Hypertension negatively affects the structure and function of cerebral blood vessels, and can lead to ischemic disease of white matter regions important for cognition. Structural and functional cerebrovascular alterations underlie many of the neuropathological abnormalities responsible for a wide range of cognitive deficits. Hypertension is a powerful modifiable risk factor for cerebrovascular damage and a large reduction in stroke mortality over the past decades has been attributed to treatment of hypertension.
This Scientific Statement is the result of an in-depth evaluation of the impact of chronic arterial hypertension and its treatment on cognitive impairment. Pathobiological effects of hypertension on the cerebral circulation are examined, as well as the cognitive domains most affected, and how they are distinct from dementia caused by other factors. Evidence on the relation between hypertension and cognition from both observational studies and randomised clinical trials of blood pressure treatment is presented. The interaction of hypertension with other risk factors is also discussed.
The link between midlife hypertension and late-life cognitive function is clear, with strong evidence suggesting a deleterious effect of high blood pressure during midlife on cognitive function in midlife and late life. Executive function and processing speed seem to be the cognitive domains most affected, as might memory, which makes it hard to distinguish vascular cognitive impairment from Alzheimer’s disease based on neurocognitive effects alone.
The effect of hypertension at a later age is less clear. There is evidence pointing towards an association between higher late-life blood pressure and better cognition. This emphasises that it may
not be adequate uniform blood pressure levels across the life course.
Clinical trials evaluating the effect of antihypertensive treatment on cognitive function have shown inconclusive results. It remains to be determined whether antihypertensive treatment can prevent or reverse cognitive decline. Other knowledge gaps are also highlighted, and the document does suggestions on how these may be addressed to advance the field.
Despite numerous outstanding questions and caveats, personalised treatment of hypertension, considering age, sex, APOE genotype, metabolic traits, comorbidities etcetera is recommended as the most promising approach to safeguard vascular and brain health.
Find this Scientific Statement online at Hypertension


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

Iadecola C, Yaffe K, Biller J et al., on behalf of the American Heart Association Council on Hypertension; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council
Hypertension. 2016;HYP.0000000000000053.
Originally published October 10, 2016