For Better Brain Health, Bring Down Your Blood Pressure

High blood pressure, especially in middle age, may put you at risk for Alzheimer’s disease and other types of dementia.

mature woman getting her blood pressure taken
It's not just your cardiovascular system that's affected by high blood pressure; it's your brain, too.Getty Images
High blood pressure, or hypertension, is often called “the silent killer” because it frequently has no symptoms but puts people at increased risk of life-threatening cardiovascular diseases, including ischemic heart disease, heart failure, and peripheral artery disease.

But while its impact on heart health is well-known, high blood pressure’s important role in brain health is only starting to emerge.

Can having high blood pressure increase your risk for Alzheimer’s disease and other types of dementia?

Here’s what top experts and the latest research say about high blood pressure, cognitive decline, and dementia, and how managing your cardiovascular risks can keep your brain healthy.

The Link Between High Blood Pressure and Changes in Cognitive Function

Many studies have found associations between high blood pressure and cognitive decline, dementia, and possibly even Alzheimer’s dementia specifically, says Rebecca Gottesman, MD, PhD, senior investigator in the stroke, cognition, and neuroepidemiology section at the National Institute of Neurological Disorder and Stroke.

“The evidence is strongest for high blood pressure in midlife as being strongly linked with these cognitive outcomes, with less clear links between high blood pressure in older age impacting cognition,” says Dr. Gottesman.

High blood pressure is also highly associated with stroke as well as so-called “silent” stroke-like changes that we can see on brain MRI, all of which are also associated with cognitive changes and dementia, she says.

High Blood Pressure in Middle Age Especially Risky for Brain Health

“We think that having high blood pressure in midlife is especially important for brain health, either because it represents a particularly important time period of vulnerability, or because people with hypertension in midlife are likely to have it for a much longer period of time,” says Gottesman.

Many people have the factors that contribute to hypertension for years or even decades before it's actually formally diagnosed, says Bibhu D. Mohanty, MD, a cardiologist at USF Health and assistant professor at the University of South Florida, both in Tampa, Florida.

“Oftentimes when it's diagnosed, it’s demonstrating that tipping-point phenomenon, where they've consistently had normal blood pressure, because the body’s adapted to maintain those normal pressures. But then all of a sudden, when they go to a doctor’s visit or they have a headache, they find their blood pressure is elevated,” says Dr. Mohanty.

The phenomenon Mohanty describes has been seen in research, where investigators found that for all ages, the trajectory for developing high blood pressure was similar: Individuals generally had stable blood pressure until their systolic pressure (the “top” number in a blood pressure reading) approached the range of 120 to 125 millimeters of mercury (mmHg). Above that threshold, blood pressure increased at a “relatively rapid rate toward overt hypertension.”

“Factors like smoking, diet, obesity, chronic lack of sleep, and chronic stress can contribute to your background blood pressure, and over time can compound to cause it to gradually rise, and then get to the point where it suddenly gets out of control,” says Mohanty.

That’s why it’s important to get your blood pressure checked regularly and to pay attention to these risk factors, he adds.

What Happens in the Brain of a Person With High Blood Pressure?

It’s likely that hypertension negatively impacts several brain processes, says Gottesman.

“Certainly one is that long-term exposure to hypertension impacts arterial and arteriolar (very tiny arteries) health over time, which can increase risk of stroke or these stroke-like imaging changes, which in turn could impact cognition and even lead to dementia in some patients,” she says.

Over time, years of hypertension may cause small clots traveling up to the brain or the accumulation of plaque that leads to reductions to blood flow, says Mohanty.

“Brain matter tries to adapt to that lack of oxygen by growing support tissue around itself, but that support tissue isn't neurologic tissue — it’s almost like a scar that's being developed in a low-grade fashion in response to lack of oxygen, but it doesn't have the capacity or the function that the brain cells, or neurons, do,” he says.

Basically, the brain’s response is generally adaptive, but that adaptation can cause its own harm, because it's trying to defend itself in a low oxygenation state, says Mohanty.

“And that can lead to gradual loss of cognitive function and loss of overall brain matter mass, and in some cases, dementia,” he says.

It's also thought that high blood pressure can alter how well the blood-brain barrier functions, and even impact the function of the glymphatic system (a pathway in the brain that appears to remove waste from the central nervous system), says Gottesman.?

“That’s a newer concept that’s been recently described and which is hypothesized to play a role in clearing toxins from the brain, including those that accumulate to cause Alzheimer’s disease,” she says.

Does Controlling High Blood Pressure Reduce the Risk for Cognitive Decline??

As of yet, most of the evidence that shows a cognitive benefit from managing blood pressure have been in observational trials, not controlled trials, says Gottesman.

But we know that physical activity and certain dietary changes are potentially promising for cognitive outcomes in general — and it’s likely that these modifications would act through improving multiple vascular risk factors including hypertension, she says.

A meta-analysis published in March 2022 found that in studies with a follow-up of at least one year, physical activity was associated with a decreased risk of all-cause dementia, Alzheimer’s disease, and vascular dementia.

There is limited evidence that treating high blood pressure actually prevents dementia or reduces cognitive decline, says Gottesman.

“One large trial, the SPRINT trial, did show that treating blood pressure more intensively to a goal of 120 systolic was associated with less mild cognitive impairment (MCI) and less combined MCI and dementia, but didn’t meet its primary study goal of reducing dementia rates. But the study was stopped early because of an overwhelming cardiovascular benefit for the group treated to the more intensive blood pressure management,” she says.

Part of the reason the clinical trials may not show a clear benefit of treatment, but that observational studies consistently show a link between hypertension and dementia, is because of the time frame when treatment might need to be given, says Gottesman.

“Because midlife hypertension is such an important risk factor for dementia, and duration of exposure to high blood pressure is probably very important, treating it for a few years in older age as part of a clinical trial may not be sufficient to show a benefit,” she says.

It’s also important to note that there is good biological evidence linking hypertension with neurodegeneration and Alzheimer’s disease, in animal models, further supporting a link, adds Gottesman.

Experts Recommend Managing High Blood Pressure and Other Cardiovascular Risk Factors?

Unless your blood pressure is extremely high or extremely low, you won’t feel it. That means your blood pressure could be high enough to raise your risk of serious problems, but without measuring it, you’d never know.

Gottesman recommends knowing your blood pressure, and if you don’t know what your blood pressure is, getting it measured.

Normal blood pressure is systolic pressure of 120 or less and diastolic pressure of 80 or less.

“If it is elevated, you should talk to your doctor about ways to bring it down. Doing this early may allow you to preserve brain health as you age,” she says.

There’s evidence to suggest that a large percentage of dementia may be prevented or delayed, meaning it’s related to risk factors that can be modified, including hypertension, diabetes, and smoking, says Gottesman.

“Anyone who has a new diagnosis of high blood pressure should talk to their doctor about what management would be best for you,” she says.

The Takeaway

Every year, researchers learn more about the risk factors for cognitive impairment and dementia. Some of those risk factors can be controlled by the individual, and some can’t. High blood pressure is one risk factor that an individual does have some control over, through a combination of healthy lifestyle habits and medication, when necessary. It’s never too early to talk to your doctor about your blood pressure and what you can do to keep it in a healthy range.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. High Blood Pressure — Understanding the Silent Killer. U.S. Food and Drug Administration. April 11, 2024.
  2. Pacholko A et al. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension. March 2024.
  3. Niiranen TJ et al. An Analysis of the Framingham Heart Study Analysis Cohort. JAMA Cardiology. May 2018.
  4. Iso-Markku PI et al. Physical Activity as a Protective Factor for Dementia and Alzheimer’s Disease: Systematic Review, Meta-Analysis and Quality Assessment of Cohort and Case-Controlled Studies. British Journal of Sports Medicine. June 2022.
  5. Can Lowering Blood Pressure Lower Risk for Dementia? SPRINT.
  6. Livingston G et al. Dementia Prevention, Intervention, and Care: 2020 Report of the Lancet Commission. The Lancet. July 30, 2020.
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