Hypertension is a cognitive health risk estimated to affect 78 million adults in the United States. That’s one in three Americans. Fortunately, physicians can help patients manage hypertension. And doing so can potentially reduce the risk of cognitive decline.
Connection Between Hypertension and Brain Health
Recently, two studies have documented the connection between hypertension and brain health. A British longitudinal study1 documented links between mid-life hypertension to increased white matter lesions, as well as smaller brain volume in late life. A separate, unrelated study2 used sophisticated MRI measurement of white matter fiber tracks to identify subtle brain changes related to impaired cognitive function in hypertensives. The authors suggest that advanced neuroimaging techniques could present an opportunity to detect early stage neurological damage and related cognitive decline associated with hypertension.
Treating Hypertension to Reduce Cognitive Health Risk
So, can vigorous treatment of hypertension positively affect cognition? The SPRINT MIND3 study has some early encouraging data.
This study — an offshoot of an initiative looking at cardiovascular and renal disease — found that intensive lowering of blood pressure showed significant reductions in risk of mild cognitive impairment. Perhaps due to methodological issues, a relationship between hypertension control and dementia was not established. However, these early results are consistent with many other studies, suggesting that positively affecting cognitive health is most likely to happen with early intervention, before the widespread damage associated with advanced dementia occurs.
Cognitive Health and Lifestyle
Recently, The Wall Street Journal published two articles on cognitive health, including “What Science Tells Us About Preventing Dementia.” The article catalogued a number of possible ways to reduce dementia risk — first and foremost, blood-pressure control.
While it’s never too late to start, making healthier lifestyle choices earlier seems to have the greatest benefit. And not just for cognitive health. Associated health consequences of hypertension include heightened risk for heart attack, stroke, congestive heart failure, aneurysm, and kidney disease.
Cognitive Testing Can Provide Additional Insight
Primary care physicians check blood pressure on every visit. Perhaps those visits should also include an assessment of cognitive function.
Until recently, assessing cognitive function was subjective. But new, digital cognitive health platforms, such as BrainCheck, can serve as a practice-ready tool to assess cognitive health as part of the physician’s comprehensive management of older individuals’ health.
- Lane CE, et al. “Associations between blood pressure across adulthood and late-life brain structure and pathology in the neuroscience substudy of the 1946 British birth cohort (Insight 46): an epidemiological study.” The Lancet, http://dx.doi.org/10.1016/S1474-4422(19)30228-5
- Carnevale L, et al. “Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging.” Cardiovascular Research. (2018) 114, 1536–1546.
- The SPRINT MIND Investigators for the SPRINT Research Group. “Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial.” JAMA. Published online January 28, 2019. 321(6):553–561. doi:10.1001/jama.2018.21442
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About the author[/vc_custom_heading][vc_column_text]Robert Cuyler is a clinical psychologist with decades of clinical, management and consulting experience. He is a Clinical Advisor at BrainCheck and the chief clinical officer of Palo Alto Health Sciences. He previously served as the CEO of JSA Health Telepsychiatry and clinical advisor to MDLive/Breakthrough Behavioral. Dr. Cuyler received his Ph.D. in psychology from Louisiana State University and his postdoctoral fellowship from the Menninger Foundation.