December 01, 2016
The lifetime risk of developing hypertension is approximately 90% in persons who reach the age of 55 years and is equal between men and women.1 Hypertension affects approximately 80 million in the United States and more than 1 billion persons worldwide.2 The risk for developing dementia is 33% for men and 45% for women.3 Dementia affects 30-40 million persons worldwide. So the immediate question that comes to mind is whether there is a link between the two disorders? The answer to this question is not immediately known. But some information is suggestive.
- Chronic hypertension is a major contributor of cognitive impairment including reduced abstract reasoning, slowing of mental processing, and memory deficits.4, 5
- Age is an important risk factor, with high BPs in midlife and lower BPs in late life increasing the risk of poor cognition.6
- Dementia caused Alzheimer’s Disease and vascular dementia pathophysiological changes appear to coexist.7-8
Can treatment of hypertension then lead to prevent or delay dementia? The answer may be yes. The Finish Geriatric Intervention Study to Prevent Cognitive Impairment and disability (FINGER) assessed a multidomain approach to prevent cognitive decline in at-risk elderly people.9 In a double-blind, randomized controlled trial of individuals age 60-77, suggest that a multidomain approach (diet, exercise, cognitive training, vascular risk monitoring [systolic and diastolic blood pressure]) could improve or maintain cognitive function.
Further information will be coming from the Systolic Blood Pressure Intervention Trial (SPRINT-MIND) which is evaluating the role of treating high blood pressure relative to cognitive impairment. The primary hypothesis of the SPRINT-MIND study is that all-cause dementia will be lower in SPRINT participants assigned to intensive treatment (goal SBP <120 mmHg) compared to standard treatment (< 140 mmHg). The hypothesis will be tested all SPRINT patients. In addition, in a subset of 2,800 participants the rate of global decline in cognition will be tested. We anxiously await these results.
At this point we should advise elderly patients to follow the FINGER trial results. Namely, adherence to a Mediterranean diet, aerobic exercise most days of the week, control of blood pressure, lipids, and glucose remains an important goal.
- Vasan RS, Beiser A, Seshadri S, Laarson MG, Kannel WB, D’Agostino RB, Levy D. Residual lifetime risk for developing hypertension in middle aged women and men: The Framingham Heart Study. JAMA 2002;287(8):1003-10.