Hypertension and Dementia
The negative impact of hypertension on cognitive function was already hinted at in the 1960s in a study on psychomotor speed of air traffic controllers and pilots and has received extensive confirmation during the following decades.1 Thus, hypertension has been associated with a wide variety of cognitive deficits, including reduced abstract reasoning (executive dysfunction), impaired memory, attention deficit, and slowing of mental processing speed.1,2 Indeed, hypertension is a leading cause of vascular cognitive impairment, a term that includes all cognitive deficits attributable to vascular factors.3 The most extreme case of vascular cognitive impairment is vascular dementia, in which multiple cognitive domains are affected, with a negative impact on the activities of daily living. Increasing evidence also suggests that hypertension is a risk factor for Alzheimer disease (AD), highlighting its participation in all major causes of cognitive impairment.4,5 In the past 3 years (2011–2013), several articles published in Hypertension have provided new insight into the link between high blood pressure and dementia. These articles will be briefly discussed, highlighting their contribution to current concepts of pathobiology, prevention, and treatment of the end-organ damage to the brain inflicted by hypertension.
Midlife Hypertension and Late-Life Dementia
Although it is well established that hypertension impairs cognition, one of the key issues still unsettled concerns the temporal relationships between blood pressure elevation and cognitive decline. On the one hand, cross-sectional studies indicated that individuals with dementia have lower blood pressure, challenging the involvement of hypertension.6 On the other hand, longitudinal studies, in which patient were followed for decades, revealed that individuals who develop dementia have a history of high blood pressure earlier in life.6,7 The effect is independent of other cardiovascular risk factors or comorbidities and is observed in both men and women. In this context, Joas et …