Blood Pressure Profiles and Cognitive Function from Adulthood to Old Age: Chasing a Golden Middle Way?

Rita Del Pinto,Raffaella Bocale,Claudio Ferri,Davide Grassi,Francesco Carubbi,Giovambattista Desideri

doi:10.3390/jcm10153243

Abstract

With the demographic shift toward advanced ages, it is imperative to understand the biological mechanisms behind common, disabling age-related diseases such as cognitive impairment in its mild form to overt dementia. Hypertension, a major cardiovascular risk factor, is epidemiologically linked to vascular and Alzheimer-type dementia, with possible mechanisms being atherosclerotic macro- and microvascular damage leading to neuronal cell death, as well as proinflammatory events responsible for neurodegeneration. Nevertheless, there is currently a knowledge gap as to which population to target, what the diagnostics test, and how to manage early pathogenic events in order to prevent such a dramatic and disabling condition. While clinical trials data support the benefit of active BP control with antihypertensive medications on the risk of future cognitive impairment, hypotension appears to be related to accelerated cognitive decline in both the fit and the cognitively frail elderly. Dedicated, technologically advanced studies assessing the relation of BP with dementia are needed to clarify the pathophysiological mechanisms in the association before a tailored preventive, diagnostic, and therapeutic approach to one of the most widespread modern medical challenges becomes a reality.

Highlights

With the progressive aging of the population and the parallel increase in the burden of age-related diseases, a clear understanding of the factors involved in the maintenance of cognitive competence and self-sufficiency throughout life carries relevant socio-economic implications
Consistent evidence indicates that hypertension control protects against cognitive deterioration and dementia through blood pressure (BP) reduction, with possible additive benefits deriving from pleiotropic effects of certain antihypertensive medications [2]
In terms of late exposure to hypertension, among 1440 Framingham Offspring participants who were free of dementia at midlife and were followed-up over an 18-year exposure period, midlife systolic hypertension (≥140 mmHg) and its persistence into late life were associated with an increased dementia risk in late life by 57% to 96%, respectively [14]

Summary

Introduction

With the progressive aging of the population and the parallel increase in the burden of age-related diseases, a clear understanding of the factors involved in the maintenance of cognitive competence and self-sufficiency throughout life carries relevant socio-economic implications. With the redefinition of BP targets during antihypertensive treatment toward lower goals and the demographic shift toward advanced ages [4], it is paramount to understand the biological mechanisms underlying the association between BP profile and cognitive performance for a proper definition of effective preventive measures and clinically oriented guidelines. In this narrative review, we summarize lights and shadows in the relation between BP and cognitive performance, with a focus on the elderly

Hypertension Control and Neuroprotection

Hypotension and Cognitive Function

Antihypertensive Drugs

Future Perspectives

Findings

Conclusions