Hypertension and its Impact on Cognitive Function

Hypertension and its Impact on Cognitive Function Hypertension; ePub 2016 Oct 10; Iadecola, et al

10-25-2016 The American Heart Association (AHA) has issued a scientific statement which examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. After a review of the literature, the study group concluded that there were insufficient data to make evidence-based recommendations but did report the following 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.

• There is a cumulative effect of hypertension on cerebrovascular damage.

The authors concluded that treatment of hypertension may safeguard vascular and brain health.

Citation: Iadecola C, Yagge K, Biller J, et al. Impact of hypertension on cognitive function. A scientific Statement from the American Heart Association. [Published online ahead of print October 10, 2016]. Hypertension. doi:10.1161/HYP.0000000000000053.

Commentary: Dementia affects over 30 million people worldwide and two of the main risk factors for the development of dementia are advancing age and hypertension. Alzheimer’s disease and multi-infarct dementia often co-exist, with hypertension a major risk factor for small–vessel disease in the brain which leads to dementia. In addition, some research shows that hypertensive vasculopathy exacerbates the accumulation of beta-amyloid in the brain, possibly contributing to the development of Alzheimer’s dementia. This review concluded that there was moderately strong evidence that hypertension leads to a decline in function in the areas of the speed of processing and executive function. Hypertension is not consistently associated with a decline in memory, one of the hallmarks of Alzheimer’s. The authors conclude with two important points: 1) “There is substantial evidence that hypertension leads to cognitive impairment, an effect attributed to oxidative stress-driven cerebrovascular dysfunction and damage” and, 2) “It is unclear whether treatment prevents cognitive decline.” —Neil Skolnik, MD