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Midlife hypertension linked to Alzheimer’s disease, vascular cognitive impairment
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Hypertension in middle age is linked to an increased risk for vascular cognitive impairment and Alzheimer’s disease in later life, according to a new scientific statement released by the American Heart Association.
“Many observational studies suggest treating hypertension may reduce the cognitive impact of high [BP], especially on vascular cognitive impairment, but observational studies are not designed to prove cause and effect,” Costantino Iadecola, MD, chair of the writing committee, said in a press release.
In the statement, the authors concluded that hypertension, by disrupting the structure and function of cerebral blood vessels, can produce ischemic damage of the white matter regions important in cognitive function, which may in turn promote the pathology seen in development of Alzheimer’s disease.
They wrote that there is strong evidence that midlife hypertension confers risk for poor cognitive function later in life, but the evidence that late-life hypertension does so is unclear.
Randomized trials of the effect of antihypertensive treatments on improvement in cognition were inconclusive, according to the authors.
Knowledge gaps include the mechanism of action of hypertension on cerebral arteries, the pathways by which structural and functional effects of hypertension on the brain produce cognitive impairment, how early in life hypertension should be treated to protect against cognitive decline and the effects of other comorbidities on the relationship between hypertension and cognitive function, the authors wrote.
“We know treating high [BP] reduces the risk of heart disease such as [MI], congestive HF and stroke, and it is important to continue treating it to reduce the risks of these diseases,” Iadecola, professor of neurology and director of the Brain and Mind Research Institute at Weill Cornell Medical College, said in the release. “However, we need randomized controlled studies — which do prove cause and effect — to determine if treating high BP, especially in middle age, will also decrease the risk of cognitive impairment later in life.” – by Dave Quaile
Disclosure: Iadecola reports no relevant financial disclosures. Please see the full statement for a list of the other authors’ and reviewers’ relevant financial disclosures.
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