Top

Published in:

Open Access 01-12-2013 | Hypertension and the Brain (M Banach and A Zanchetti, Section Editors)

Hypertension, Brain Damage and Cognitive Decline

Authors: Dariusz Gąsecki, Mariusz Kwarciany, Walenty Nyka, Krzysztof Narkiewicz

Published in: Current Hypertension Reports | Issue 6/2013

Abstract

Loss of cognitive function is one the most devastating manifestations of ageing and vascular disease. Cognitive decline is rapidly becoming an important cause of disability worldwide and contributes significantly to increased mortality. There is growing evidence that hypertension is the most important modifiable vascular risk factor for development and progression of both cognitive decline and dementia. High blood pressure contributes to cerebral small and large vessel disease resulting in brain damage and dementia. A decline in cerebrovascular reserve capacity and emerging degenerative vascular wall changes underlie complete and incomplete brain infarcts, haemorrhages and white matter hyperintensities. This review discusses the complexity of factors linking hypertension to brain functional and structural changes, and to cognitive decline and dementia. The evidence for possible clinical markers useful for prevention of decreased cognitive ability, as well as recent data on vascular mechanism in the pathogenesis of cognitive decline, and the role of antihypertensive therapies in long-term prevention of late-life cognitive decline will be reviewed.

MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765–74.PubMed

Jellinger KA, Attems J. Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol. 2010;119(4):421–33. doi:10.1007/s00401-010-0654-5.PubMed

• Nelson PT, Head E, Schmitt FA, Davis PR, Neltner JH, Jicha GA, et al. Alzheimer’s disease is not “brain aging”: neuropathological, genetic, and epidemiological human studies. Acta Neuropathol. 2011;121(5):571–87. doi:10.1007/s00401-011-0826-y. Analysis of specific pathways involved in Alzheimer disease.PubMed

Barodka VM, Joshi BL, Berkowitz DE, Hogue CW, Nyhan D. Review article: implications of vascular aging. Anesth Analg. 2011;112(5):1048–60. doi:10.1213/ANE.0b013e3182147e3c.PubMed

Wimo A, Winblad B, Aguero-Torres H, von Strauss E. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord. 2003;17(2):63–7.PubMed

Wimo A, Winblad B, Jonsson L. The worldwide societal costs of dementia: estimates for 2009. Alzheimers Dement. 2010;6(2):98–103. doi:10.1016/j.jalz.2010.01.010.PubMed

Jicha GA, Parisi JE, Dickson DW, Johnson K, Cha R, Ivnik RJ, et al. Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia. Arch Neurol. 2006;63(5):674–81. doi:10.1001/archneur.63.5.674.PubMed

Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58(12):1985–92.PubMed

Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8.PubMed

10.

Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3–18.PubMed

11.

Ruitenberg A, Ott A, van Swieten JC, Hofman A, Breteler MM. Incidence of dementia: does gender make a difference? Neurobiol Aging. 2001;22(4):575–80.PubMed

12.

Roman GC. Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention. Med Clin North Am. 2002;86(3):477–99.PubMed

13.

•• Toledo JB, Arnold SE, Raible K, Brettschneider J, Xie SX, Grossman M, et al. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer’s Coordinating Centre. Brain. 2013. doi:10.1093/brain/awt188. Article summarizing the contribution of cerebrovascular disease to neurodegenerative diseases confirmed by autopsy.PubMed

14.

Jellinger KA, Attems J. Neuropathology and general autopsy findings in nondemented aged subjects. Clin Neuropathol. 2012;31(2):87–98.PubMed

15.

Chui HC, Zarow C, Mack WJ, Ellis WG, Zheng L, Jagust WJ, et al. Cognitive impact of subcortical vascular and Alzheimer’s disease pathology. Ann Neurol. 2006;60(6):677–87. doi:10.1002/ana.21009.PubMed

16.

Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA. 1997;277(10):813–7.PubMed

17.

Shehab A, Abdulle A. Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension. BMC Cardiovasc Disord. 2011;11:3. doi:10.1186/1471-2261-11-3.PubMed

18.

Mahoney JR, Verghese J, Goldin Y, Lipton R, Holtzer R. Alerting, orienting, and executive attention in older adults. J Int Neuropsychol Soc. 2010;16(5):877–89. doi:10.1017/s1355617710000767.PubMed

19.

Richmond R, Law J, Kay-Lambkin F. Higher blood pressure associated with higher cognition and functionality among centenarians in Australia. Am J Hypertens. 2011;24(3):299–303. doi:10.1038/ajh.2010.236.PubMed

20.

Szewieczek J, Dulawa J, Gminski J, Kurek A, Legierska K, Francuz T, et al. Better cognitive and physical performance is associated with higher blood pressure in centenarians. J Nutr Health Aging. 2011;15(8):618–22.PubMed

21.

Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA. 1995;274(23):1846–51.PubMed

22.

Elias MF, Wolf PA, D’Agostino RB, Cobb J, White LR. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993;138(6):353–64.PubMed

23.

Whitmer RA, Sidney S, Selby J, Johnston SC, Yaffe K. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology. 2005;64(2):277–81. doi:10.1212/01.wnl.0000149519.47454.f2.PubMed

24.

Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4(8):487–99. doi:10.1016/s1474-4422(05)70141-1.PubMed

25.

Launer LJ, Ross GW, Petrovitch H, Masaki K, Foley D, White LR, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging. 2000;21(1):49–55.PubMed

26.

Yamada M, Kasagi F, Sasaki H, Masunari N, Mimori Y, Suzuki G. Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. J Am Geriatr Soc. 2003;51(3):410–4.PubMed

27.

Goldstein FC, Levey AI, Steenland NK. High blood pressure and cognitive decline in mild cognitive impairment. J Am Geriatr Soc. 2013;61(1):67–73. doi:10.1111/jgs.12067.PubMed

28.

Reijmer YD, van den Berg E, Dekker JM, Nijpels G, Stehouwer CD, Kappelle LJ, et al. Development of vascular risk factors over 15 years in relation to cognition: the Hoorn Study. J Am Geriatr Soc. 2012;60(8):1426–33. doi:10.1111/j.1532-5415.2012.04081.x.PubMed

29.

• Launer LJ, Hughes T, Yu B, Masaki K, Petrovitch H, Ross GW, et al. Lowering midlife levels of systolic blood pressure as a public health strategy to reduce late-life dementia: perspective from the Honolulu Heart Program/Honolulu Asia Aging Study. Hypertension. 2010;55(6):1352–9. doi:10.1161/hypertensionaha.109.147389. Important study indicating that reduction of SBP may be effective in prevention of late-life dementia.PubMed

30.

• Ronnemaa E, Zethelius B, Lannfelt L, Kilander L. Vascular risk factors and dementia: 40-year follow-up of a population-based cohort. Dement Geriatr Cogn Disord. 2011;31(6):460–6. doi:10.1159/000330020. Seminal study showing in a long-term follow-up (up to 40 years) that vascular risk factors increase the risk of dementia, particularly vascular and mixed dementia, but not AD.PubMed

31.

Laitala VS, Kaprio J, Koskenvuo M, Raiha I, Rinne JO, Silventoinen K. Association and causal relationship of midlife obesity and related metabolic disorders with old age cognition. Curr Alzheimer Res. 2011;8(6):699–706.PubMed

32.

Banach M, Hering D, Narkiewicz K, Mysliwiec M, Rysz J, Malyszko J. Lipids, blood pressure, kidney-what was new in 2012? Int J Pharmacol. 2012;8(8):659–78.

33.

Banach M, Nikfar S, Rahimi R, Bielecka-Dabrowa A, Pencina MJ, Mikhailidis DP, et al. The effects of statins on blood pressure in normotensive or hypertensive subjects - A meta-analysis of randomized controlled trials. Int J Cardiol. 2013. doi:10.1016/j.ijcard.2013.03.068.

34.

Banach M, Aronow WS. Hypertension therapy in the older adults-do we know the answers to all the questions? The status after publication of the ACCF/AHA 2011 expert consensus document on hypertension in the elderly. J Hum Hypertens. 2012;26(11):641–3. doi:10.1038/jhh.2012.3.PubMed

35.

Tzourio C, Dufouil C, Ducimetiere P, Alperovitch A. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology. 1999;53(9):1948–52.PubMed

36.

Elias MF, Elias PK, Sullivan LM, Wolf PA, D’Agostino RB. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes Relat Metab Disord. 2003;27(2):260–8. doi:10.1038/sj.ijo.802225.PubMed

37.

Hebert LE, Scherr PA, Bennett DA, Bienias JL, Wilson RS, Morris MC, et al. Blood pressure and late-life cognitive function change: a biracial longitudinal population study. Neurology. 2004;62(11):2021–4.PubMed

38.

Tervo S, Kivipelto M, Hanninen T, Vanhanen M, Hallikainen M, Mannermaa A, et al. Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord. 2004;17(3):196–203. doi:10.1159/000076356.PubMed

39.

Glynn RJ, Beckett LA, Hebert LE, Morris MC, Scherr PA, Evans DA. Current and remote blood pressure and cognitive decline. JAMA. 1999;281(5):438–45.PubMed

40.

Bohannon AD, Fillenbaum GG, Pieper CF, Hanlon JT, Blazer DG. Relationship of race/ethnicity and blood pressure to change in cognitive function. J Am Geriatr Soc. 2002;50(3):424–9.PubMed

41.

Yasar S, Ko JY, Nothelle S, Mielke MM, Carlson MC. Evaluation of the effect of systolic blood pressure and pulse pressure on cognitive function: the Women’s Health and Aging Study II. PLoS One. 2011;6(12):e27976. doi:10.1371/journal.pone.0027976.PubMed

42.

Kimm H, Lee PH, Shin YJ, Park KS, Jo J, Lee Y, et al. Mid-life and late-life vascular risk factors and dementia in Korean men and women. Arch Gerontol Geriatr. 2011;52(3):e117–22. doi:10.1016/j.archger.2010.09.004.PubMed

43.

Ninomiya T, Ohara T, Hirakawa Y, Yoshida D, Doi Y, Hata J, et al. Midlife and late-life blood pressure and dementia in Japanese elderly: the Hisayama study. Hypertension. 2011;58(1):22–8. doi:10.1161/hypertensionaha.110.163055.PubMed

44.

Oveisgharan S, Hachinski V. Hypertension, executive dysfunction, and progression to dementia: the canadian study of health and aging. Arch Neurol. 2010;67(2):187–92. doi:10.1001/archneurol.2009.312.PubMed

45.

Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson LA, Nilsson L, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996;347(9009):1141–5.PubMed

46.

Molander L, Gustafson Y, Lovheim H. Longitudinal associations between blood pressure and dementia in the very old. Dement Geriatr Cogn Disord. 2010;30(3):269–76. doi:10.1159/000320252.PubMed

47.

Staessen JA, Richart T, Birkenhager WH. Less atherosclerosis and lower blood pressure for a meaningful life perspective with more brain. Hypertension. 2007;49(3):389–400. doi:10.1161/01.HYP.0000258151.00728.d8.PubMed

48.

Kivipelto M, Helkala EL, Laakso MP, Hanninen T, Hallikainen M, Alhainen K, et al. Midlife vascular risk factors and Alzheimer’s disease in later life: longitudinal, population based study. BMJ. 2001;322(7300):1447–51.PubMed

49.

Wu C, Zhou D, Wen C, Zhang L, Como P, Qiao Y. Relationship between blood pressure and Alzheimer’s disease in Linxian County, China. Life Sci. 2003;72(10):1125–33.PubMed

50.

Ueda K, Kawano H, Hasuo Y, Fujishima M. Prevalence and etiology of dementia in a Japanese community. Stroke. 1992;23(6):798–803.PubMed

51.

Kuusisto J, Koivisto K, Mykkanen L, Helkala EL, Vanhanen M, Hanninen T, et al. Association between features of the insulin resistance syndrome and Alzheimer’s disease independently of apolipoprotein E4 phenotype: cross sectional population based study. BMJ. 1997;315(7115):1045–9.PubMed

52.

Brayne C, Gill C, Huppert FA, Barkley C, Gehlhaar E, Girling DM, et al. Vascular risks and incident dementia: results from a cohort study of the very old. Dement Geriatr Cogn Disord. 1998;9(3):175–80.PubMed

53.

Posner HB, Tang MX, Luchsinger J, Lantigua R, Stern Y, Mayeux R. The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology. 2002;58(8):1175–81.PubMed

54.

Qiu C, von Strauss E, Fastbom J, Winblad B, Fratiglioni L. Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Arch Neurol. 2003;60(2):223–8.PubMed

55.

Yang YH, Roe CM, Morris JC. Relationship between late-life hypertension, blood pressure, and Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2011;26(6):457–62. doi:10.1177/1533317511421779.PubMed

56.

Farkas E, Luiten PG. Cerebral microvascular pathology in aging and Alzheimer’s disease. Prog Neurobiol. 2001;64(6):575–611.PubMed

57.

Kalaria RN. Linking cerebrovascular defense mechanisms in brain ageing and Alzheimer’s disease. Neurobiol Aging. 2009;30(9):1512–4. doi:10.1016/j.neurobiolaging.2007.10.020.PubMed

58.

Park L, Anrather J, Girouard H, Zhou P, Iadecola C. Nox2-derived reactive oxygen species mediate neurovascular dysregulation in the aging mouse brain. J Cereb Blood Flow Metab. 2007;27(12):1908–18. doi:10.1038/sj.jcbfm.9600491.PubMed

59.

• Hajjar I, Zhao P, Alsop D, Novak V. Hypertension and cerebral vasoreactivity: a continuous arterial spin labeling magnetic resonance imaging study. Hypertension. 2010;56(5):859–64. doi:10.1161/hypertensionaha.110.160002. This article provides an interesting explanation of the role of hypertension in impairments in mobility, cognition, and mood.PubMed

60.

Hajjar I, Quach L, Yang F, Chaves PH, Newman AB, Mukamal K, et al. Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study. Circulation. 2011;123(8):858–65. doi:10.1161/circulationaha.110.978114.PubMed

61.

Panerai RB. Assessment of cerebral pressure autoregulation in humans–a review of measurement methods. Physiol Meas. 1998;19(3):305–38.PubMed

62.

Lojkowska W, Ryglewicz D, Jedrzejczak T, Minc S, Jakubowska T, Jarosz H, et al. The effect of cholinesterase inhibitors on the regional blood flow in patients with Alzheimer’s disease and vascular dementia. J Neurol Sci. 2003;216(1):119–26.PubMed

63.

• Appelman AP, Vincken KL, van der Graaf Y, Vlek AL, Witkamp TD, Mali WP, et al. White matter lesions and lacunar infarcts are independently and differently associated with brain atrophy: the SMART-MR study. Cerebrovasc Dis. 2010;29(1):28–35. doi:10.1159/000255971. Important study suggesting an independent role for WML in the pathogenesis of brain atrophy.PubMed

64.

Romanowski CA, Wilkinson ID. Atrophy: when too much atrophy is too little brain. Neuroradiology. 2011;53 Suppl 1:S133–9. doi:10.1007/s00234-011-0929-0.PubMed

65.

Raz N, Rodrigue KM, Haacke EM. Brain aging and its modifiers: insights from in vivo neuromorphometry and susceptibility weighted imaging. Ann N Y Acad Sci. 2007;1097:84–93. doi:10.1196/annals.1379.018.PubMed

66.

Raz N, Rodrigue KM, Kennedy KM, Acker JD. Vascular health and longitudinal changes in brain and cognition in middle-aged and older adults. Neuropsychology. 2007;21(2):149–57. doi:10.1037/0894-4105.21.2.149.PubMed

67.

Raz N, Lindenberger U, Rodrigue KM, Kennedy KM, Head D, Williamson A, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676–89. doi:10.1093/cercor/bhi044.PubMed

68.

Chen X, Wen W, Anstey KJ, Sachdev PS. Effects of cerebrovascular risk factors on gray matter volume in adults aged 60-64 years: a voxel-based morphometric study. Psychiatry Res. 2006;147(2–3):105–14. doi:10.1016/j.pscychresns.2006.01.009.PubMed

69.

Taki Y, Goto R, Evans A, Zijdenbos A, Neelin P, Lerch J, et al. Voxel-based morphometry of human brain with age and cerebrovascular risk factors. Neurobiol Aging. 2004;25(4):455–63. doi:10.1016/j.neurobiolaging.2003.09.002.PubMed

70.

Strassburger TL, Lee HC, Daly EM, Szczepanik J, Krasuski JS, Mentis MJ, et al. Interactive effects of age and hypertension on volumes of brain structures. Stroke. 1997;28(7):1410–7.PubMed

71.

Gunning-Dixon FM, Brickman AM, Cheng JC, Alexopoulos GS. Aging of cerebral white matter: a review of MRI findings. Int J Geriatr Psychiatry. 2009;24(2):109–17. doi:10.1002/gps.2087.PubMed

72.

Hachinski VC, Potter P, Merskey H. Leuko-araiosis. Arch Neurol. 1987;44(1):21–3.PubMed

73.

• Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010;341:c3666. doi:10.1136/bmj.c3666. A systematic analysis of clinical relevance of WMH.PubMed

74.

Xiong YY, Mok V. Age-related white matter changes. J Aging Res. 2011;2011:617927. doi:10.4061/2011/617927.PubMed

75.

•• Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701. doi:10.1016/S1474-4422(10)70104-6. Elegant review summarizing the evidence linking cerebral WMH to pathogenesis and clinical characteristics of cognitive decline.PubMed

76.

Skoog I. A review on blood pressure and ischaemic white matter lesions. Dement Geriatr Cogn Disord. 1998;9 Suppl 1:13–9.PubMed

77.

Longstreth Jr WT, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996;27(8):1274–82.PubMed

78.

• Verhaaren BF, Vernooij MW, de Boer R, Hofman A, Niessen WJ, van der Lugt A, et al. High blood pressure and cerebral white matter lesion progression in the general population. Hypertension. 2013;61(6):1354–9. doi:10.1161/hypertensionaha.111.00430. This study demonstrates that hypertension treatment could reduce WML progression in the general population.PubMed

79.

Knopman DS, Penman AD, Catellier DJ, Coker LH, Shibata DK, Sharrett AR, et al. Vascular risk factors and longitudinal changes on brain MRI: the ARIC study. Neurology. 2011;76(22):1879–85. doi:10.1212/WNL.0b013e31821d753f.PubMed

80.

Marcus J, Gardener H, Rundek T, Elkind MS, Sacco RL, Decarli C, et al. Baseline and longitudinal increases in diastolic blood pressure are associated with greater white matter hyperintensity volume: the northern Manhattan study. Stroke. 2011;42(9):2639–41. doi:10.1161/strokeaha.111.617571.PubMed

81.

Raz N, Yang YQ, Rodrigue KM, Kennedy KM, Lindenberger U, Ghisletta P. White matter deterioration in 15 months: latent growth curve models in healthy adults. Neurobiol Aging. 2012;33(2):429.e1-5. doi:10.1016/j.neurobiolaging.2010.11.018.PubMed

82.

Salat DH, Williams VJ, Leritz EC, Schnyer DM, Rudolph JL, Lipsitz LA, et al. Inter-individual variation in blood pressure is associated with regional white matter integrity in generally healthy older adults. Neuroimage. 2012;59(1):181–92. doi:10.1016/j.neuroimage.2011.07.033.PubMed

83.

Raz N, Yang Y, Dahle CL, Land S. Volume of white matter hyperintensities in healthy adults: contribution of age, vascular risk factors, and inflammation-related genetic variants. Biochim Biophys Acta. 2012;1822(3):361–9. doi:10.1016/j.bbadis.2011.08.007.PubMed

84.

Murray AD, Staff RT, McNeil CJ, Salarirad S, Starr JM, Deary IJ, et al. Brain lesions, hypertension and cognitive ageing in the 1921 and 1936 Aberdeen birth cohorts. Age (Dordr). 2012;34(2):451–9. doi:10.1007/s11357-011-9233-5.

85.

Maillard P, Carmichael O, Fletcher E, Reed B, Mungas D, DeCarli C. Coevolution of white matter hyperintensities and cognition in the elderly. Neurology. 2012;79(5):442–8. doi:10.1212/WNL.0b013e3182617136.PubMed

86.

Haan M, Espeland MA, Klein BE, Casanova R, Gaussoin SA, Jackson RD, et al. Cognitive function and retinal and ischemic brain changes: the Women’s Health Initiative. Neurology. 2012;78(13):942–9. doi:10.1212/WNL.0b013e31824d9655.PubMed

87.

Loitfelder M, Seiler S, Schwingenschuh P, Schmidt R. Cerebral microbleeds: a review. Panminerva Med. 2012;54(3):149–60.PubMed

88.

Waldstein SR, Rice SC, Thayer JF, Najjar SS, Scuteri A, Zonderman AB. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension. 2008;51(1):99–104. doi:10.1161/hypertensionaha.107.093674.PubMed

89.

Qiu C, Winblad B, Viitanen M, Fratiglioni L. Pulse pressure and risk of Alzheimer disease in persons aged 75 years and older: a community-based, longitudinal study. Stroke. 2003;34(3):594–9. doi:10.1161/01.str.0000060127.96986.f4.PubMed

90.

Lee AY, Jeong SH, Choi BH, Sohn EH, Chui H. Pulse pressure correlates with leukoaraiosis in Alzheimer disease. Arch Gerontol Geriatr. 2006;42(2):157–66. doi:10.1016/j.archger.2005.06.009.PubMed

91.

Weller RO, Boche D, Nicoll JA. Microvasculature changes and cerebral amyloid angiopathy in Alzheimer’s disease and their potential impact on therapy. Acta Neuropathol. 2009;118(1):87–102. doi:10.1007/s00401-009-0498-z.PubMed

92.

Kearney-Schwartz A, Rossignol P, Bracard S, Felblinger J, Fay R, Boivin JM, et al. Vascular structure and function is correlated to cognitive performance and white matter hyperintensities in older hypertensive patients with subjective memory complaints. Stroke. 2009;40(4):1229–36. doi:10.1161/strokeaha.108.532853.PubMed

93.

Nation DA, Wierenga CE, Delano-Wood L, Jak AJ, Delis DC, Salmon DP, et al. Elevated pulse pressure is associated with age-related decline in language ability. J Int Neuropsychol Soc. 2010;16(5):933–8. doi:10.1017/s1355617710000548.PubMed

94.

Pase MP, Pipingas A, Kras M, Nolidin K, Gibbs AL, Wesnes KA, et al. Healthy middle-aged individuals are vulnerable to cognitive deficits as a result of increased arterial stiffness. J Hypertens. 2010;28(8):1724–9. doi:10.1097/HJH.0b013e32833b1ee7.PubMed

95.

Nation DA, Delano-Wood L, Bangen KJ, Wierenga CE, Jak AJ, Hansen LA, et al. Antemortem pulse pressure elevation predicts cerebrovascular disease in autopsy-confirmed Alzheimer’s disease. J Alzheimers Dis. 2012;30(3):595–603. doi:10.3233/jad-2012-111697.PubMed

96.

• Rabkin SW, Jarvie G. Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment. Blood Press. 2011;20(5):274–83. doi:10.3109/08037051.2011.566246. This paper systematically analyzes the associations between vascular stiffness and cognitive function and shows that vascular stiffness is greater in VaD compared with AD.PubMed

97.

Zhong W, Cruickshanks KJ, Schubert CR, Carlsson CM, Chappell RJ, Klein BE, et al. Pulse Wave Velocity and Cognitive Function in Older Adults. Alzheimer Dis Assoc Disord. 2013. doi:10.1097/WAD.0b013e3182949f06.PubMed

98.

Diz DI, Lewis K. Dahl memorial lecture: the renin-angiotensin system and aging. Hypertension. 2008;52(1):37–43. doi:10.1161/HYPERTENSIONAHA.107.108985.PubMed

99.

Gustafson DR, Melchior L, Eriksson E, Sundh V, Blennow K, Skoog I. The ACE insertion deletion polymorphism relates to dementia by metabolic phenotype, APOEepsilon4, and age of dementia onset. Neurobiol Aging. 2010;31(6):910–6. doi:10.1016/j.neurobiolaging.2008.07.015.PubMed

100.

Bourassa EA, Sved AF, Speth RC. Angiotensin modulation of rostral ventrolateral medulla (RVLM) in cardiovascular regulation. Mol Cell Endocrinol. 2009;302(2):167–75. doi:10.1016/j.mce.2008.10.039.PubMed

101.

Basso N, Paglia N, Stella I, de Cavanagh EM, Ferder L, del Rosario Lores Arnaiz M, et al. Protective effect of the inhibition of the renin-angiotensin system on aging. Regul Pept. 2005;128(3):247–52. doi:10.1016/j.regpep.2004.12.027.PubMed

102.

Berti V, Osorio RS, Mosconi L, Li Y, De Santi S, de Leon MJ. Early detection of Alzheimer’s disease with PET imaging. Neurodegener Dis. 2010;7(1–3):131–5. doi:10.1159/000289222.PubMed

103.

Attwell D, Iadecola C. The neural basis of functional brain imaging signals. Trends Neurosci. 2002;25(12):621–5.PubMed

104.

de Leon MJ, Convit A, Wolf OT, Tarshish CY, DeSanti S, Rusinek H, et al. Prediction of cognitive decline in normal elderly subjects with 2-[(18)F]fluoro-2-deoxy-D-glucose/poitron-emission tomography (FDG/PET). Proc Natl Acad Sci U S A. 2001;98(19):10966–71. doi:10.1073/pnas.191044198.PubMed

105.

Mosconi L, Berti V, Glodzik L, Pupi A, De Santi S, de Leon MJ. Pre-clinical detection of Alzheimer’s disease using FDG-PET, with or without amyloid imaging. J Alzheimers Dis. 2010;20(3):843–54. doi:10.3233/JAD-2010-091504.PubMed

106.

Raber J, Huang Y, Ashford JW. ApoE genotype accounts for the vast majority of AD risk and AD pathology. Neurobiol Aging. 2004;25(5):641–50. doi:10.1016/j.neurobiolaging.2003.12.023.PubMed

107.

Chuang YF, Hayden KM, Norton MC, Tschanz J, Breitner JC, Welsh-Bohmer KA, et al. Association between APOE epsilon4 allele and vascular dementia: the Cache County study. Dement Geriatr Cogn Disord. 2010;29(3):248–53. doi:10.1159/000285166.PubMed

108.

Yasuno F, Tanimukai S, Sasaki M, Ikejima C, Yamashita F, Kodama C, et al. Effect of plasma lipids, hypertension and APOE genotype on cognitive decline. Neurobiol Aging. 2012;33(11):2633–40. doi:10.1016/j.neurobiolaging.2011.12.028.PubMed

109.

Schuur M, van Swieten JC, Schol-Gelok S, Ikram MA, Vernooij MW, Liu F, et al. Genetic risk factors for cerebral small-vessel disease in hypertensive patients from a genetically isolated population. J Neurol Neurosurg Psychiatry. 2011;82(1):41–4. doi:10.1136/jnnp.2009.176362.PubMed

110.

Markovitz JH, Jonas BS, Davidson K. Psychologic factors as precursors to hypertension. Curr Hypertens Rep. 2001;3(1):25–32.PubMed

111.

Sparrenberger F, Cichelero FT, Ascoli AM, Fonseca FP, Weiss G, Berwanger O, et al. Does psychosocial stress cause hypertension? A systematic review of observational studies. J Hum Hypertens. 2009;23(1):12–9. doi:10.1038/jhh.2008.74.PubMed

112.

• Jennings JR, Heim AF. From brain to behavior: hypertension’s modulation of cognition and affect. Int J Hypertens. 2012;2012:701385. doi:10.1155/2012/701385. This review provides evidence for an impact of blood pressure on the psychological factors.PubMed

113.

Jennings JR, Zanstra Y. Is the brain the essential in hypertension? Neuroimage. 2009;47(3):914–21. doi:10.1016/j.neuroimage.2009.04.072.PubMed

114.

•• Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42(9):2672–713. doi:10.1161/STR.0b013e3182299496. Statement summarizing the current knowledge regarding the contribution of vascular risk factors to cognitive impairment and dementia.PubMed

115.

• Anderson C, Teo K, Gao P, Arima H, Dans A, Unger T, et al. Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the ONTARGET and TRANSCEND studies. Lancet Neurol. 2011;10(1):43–53. doi:10.1016/s1474-4422(10)70250-7. This article summarizes the effects of different approaches of RAA system inhibition on cognitive outcomes in ONTARGET/TRANSCEND trial.PubMed

116.

• Staessen JA, Thijs L, Richart T, Odili AN, Birkenhager WH. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension. vol 2. United States2011. p. e6-7. An update of the meta-analysis of the placebo controlled trials regarding the blood-pressure lowering therapies for the primary prevention of dementia.

117.

Hanon O, Berrou JP, Negre-Pages L, Goch JH, Nadhazi Z, Petrella R, et al. Effects of hypertension therapy based on eprosartan on systolic arterial blood pressure and cognitive function: primary results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction open-label study. J Hypertens. 2008;26(8):1642–50. doi:10.1097/HJH.0b013e328301a280.PubMed

118.

Petrella RJ, Shlyakhto E, Konradi AO, Berrou JP, Sedefdjian A, Pathak A. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich). 2012;14(2):78–84. doi:10.1111/j.1751-7176.2011.00577.x.

119.

Kume K, Hanyu H, Sakurai H, Takada Y, Onuma T, Iwamoto T. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int. 2012;12(2):207–14. doi:10.1111/j.1447-0594.2011.00746.x.PubMed

120.

van Vliet P, Westendorp RG, van Heemst D, de Craen AJ, Oleksik AM. Cognitive decline precedes late-life longitudinal changes in vascular risk factors. J Neurol Neurosurg Psychiatry. 2010;81(9):1028–32. doi:10.1136/jnnp.2009.182519.PubMed

121.

Vicario A, del Sueldo MA, Zilberman JM, Cerezo GH. Cognitive evolution in hypertensive patients: a six-year follow-up. Vasc Health Risk Manag. 2011;7:281–5. doi:10.2147/vhrm.s18777.PubMed

122.

Vuorinen M, Solomon A, Rovio S, Nieminen L, Kareholt I, Tuomilehto J, et al. Changes in vascular risk factors from midlife to late life and white matter lesions: a 20-year follow-up study. Dement Geriatr Cogn Disord. 2011;31(2):119–25. doi:10.1159/000323810.PubMed

123.

Watfa G, Rossignol P, Kearney-Schwartz A, Fay R, Bracard S, Felblinger J, et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens. 2010;28(12):2485–93. doi:10.1097/HJH.0b013e32833e4108.PubMed

124.

• Jennings JR, Mendelson DN, Muldoon MF, Ryan CM, Gianaros PJ, Raz N, et al. Regional grey matter shrinks in hypertensive individuals despite successful lowering of blood pressure. J Hum Hypertens. 2012;26(5):295–305. doi:10.1038/jhh.2011.31. This is a novel study demonstrating that essential hypertension is associated with grey matter shrinkage, and that reduction of BP may not counter that trend.PubMed

125.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. doi:10.1097/01.hjh.0000431740.32696.cc.PubMed

126.

Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011;10(9):819–28. doi:10.1016/s1474-4422(11)70072-2.PubMed

127.

Jefferson AL, Tate DF, Poppas A, Brickman AM, Paul RH, Gunstad J, et al. Lower cardiac output is associated with greater white matter hyperintensities in older adults with cardiovascular disease. J Am Geriatr Soc. 2007;55(7):1044–8. doi:10.1111/j.1532-5415.2007.01226.x.PubMed

128.

Singh-Manoux A, Sabia S, Kivimaki M, Shipley MJ, Ferrie JE, Marmot MG. Cognition and incident coronary heart disease in late midlife: the Whitehall II study. Intelligence. 2009;37(6):529–34. doi:10.1016/j.intell.2008.12.001.PubMed

129.

Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE, Hofman A. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28(2):316–21.PubMed

130.

Kähönen-Väre M, Brunni-Hakala S, Lindroos M, Pitkala K, Strandberg T, Tilvis R. Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age. Aging Clin Exp Res. 2004;16(2):147–52.PubMed

131.

Mitchell GF, van Buchem MA, Sigurdsson S, Gotal JD, Jonsdottir MK, Kjartansson Ó, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility–Reykjavik study. Brain. 2011;134(Pt 11):3398–407. doi:10.1093/brain/awr253.PubMed

132.

Kotze MJ, van Rensburg SJ. Pathology supported genetic testing and treatment of cardiovascular disease in middle age for prevention of Alzheimer’s disease. Metab Brain Dis. 2012;27(3):255–66. doi:10.1007/s11011-012-9296-8.PubMed

133.

Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5(1):64–74. doi:10.1016/s1474-4422(05)70284-2.PubMed

134.

Fitzpatrick AL, Kuller LH, Lopez OL, Diehr P, O’Meara ES, Longstreth WT, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol. 2009;66(3):336–42. doi:10.1001/archneurol.2008.582.PubMed

135.

Mielke MM, Zandi PP, Shao H, Waern M, Östling S, Guo X, et al. The 32-year relationship between cholesterol and dementia from midlife to late life. Neurology. 2010;75(21):1888–95. doi:10.1212/WNL.0b013e3181feb2bf.PubMed

136.

Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C, et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683–9. doi:10.1016/S1474-4422(08)70143-1.PubMed

137.

Grassi D, Ferri L, Cheli P, Di Giosia P, Ferri C. Cognitive decline as a consequence of essential hypertension. Curr Pharm Des. 2011;17(28):3032–8.PubMed

138.

Guan JW, Huang CQ, Li YH, Wan CM, You C, Wang ZR, et al. No association between hypertension and risk for Alzheimer’s disease: a meta-analysis of longitudinal studies. J Alzheimers Dis. 2011;27(4):799–807. doi:10.3233/jad-2011-111160.PubMed

139.

Duron E, Hanon O. Antihypertensive treatments, cognitive decline, and dementia. J Alzheimers Dis. 2010;20(3):903–14. doi:10.3233/jad-2010-091552.PubMed

140.

Richard E, Andrieu S, Solomon A, Mangialasche F, Ahtiluoto S, Moll van Charante EP, et al. Methodological challenges in designing dementia prevention trials - the European Dementia Prevention Initiative (EDPI). J Neurol Sci. 2012;322(1–2):64–70.PubMed

Title: Hypertension, Brain Damage and Cognitive Decline
Authors: Dariusz Gąsecki
Mariusz Kwarciany
Walenty Nyka
Krzysztof Narkiewicz
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Hypertension Reports / Issue 6/2013
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI: https://doi.org/10.1007/s11906-013-0398-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2013

An Update on the Salt Wars—Genuine Controversy, Poor Science, or Vested Interest?

Genetics and the Molecular Pathogenesis of Pulmonary Arterial Hypertension

Hypertension-Related Stroke Prevention in the Elderly

Physical Activity and the Prevention of Hypertension

Dietary Approaches to Prevent Hypertension

An Update on Medical Therapy for Pulmonary Arterial Hypertension

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage