Hypertension and mild cognitive impairment: state-of-the-art review

Sultana Shajahan; Ruth Peters; Cheryl Carcel; Mark Woodward; Katie Harris; Craig S Anderson

doi:10.1093/ajh/hpae007

Hypertension and mild cognitive impairment: state-of-the-art review

Am J Hypertens. 2024 Jan 12:hpae007. doi: 10.1093/ajh/hpae007. Online ahead of print.

Authors

Sultana Shajahan¹, Ruth Peters¹, Cheryl Carcel^{1

2}, Mark Woodward^{1

3}, Katie Harris¹, Craig S Anderson^{1

4}

Affiliations

¹ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
² Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia.
³ The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
⁴ Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia.

PMID: 38214550
DOI: 10.1093/ajh/hpae007

Abstract

Background: Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). However, there is still limited direct evidence to support the approach, and particularly for the treatment of the very old and those with existing MCI.

Methods: This review presents an overview of the current evidence for the relationship between MCI and hypertension, and of the potential pathophysiological mechanisms related to cognitive decline and incidence dementia in relation to aging.

Results: Although observational data are near consistent in showing an association between mid-life hypertension and MCI and/or dementia, the evidence in relation to hypertension in younger adults and the very old (age >80 years) is much more limited. Most of the commonly available antihypertensive agents appear to provide beneficial effects in reducing the risk dementia, but there is limited evidence to support such treatment in those with existing MCI.

Conclusions: Further studies are needed to determine the optimal levels of BP control across different age groups, especially in adults with MCI, and which class(es) of antihypertensive agents and duration of treatment best preserve cognitive function in those at risk of, or with established, MCI.

Keywords: MCI; blood pressure; cognition; dementia; hypertension; mild cognitive impairment.