Brain function and blood pressure are deeply connected. Despite being only a fortieth of our bodyweight, the brain receives nearly a fifth of our cardiac output. Such a large percentage is unique to humans, possibly because of the increasing metabolic needs of the brain during evolution. 1 Seymour RS Bosiocic V Snelling EP Correction to 'Fossil skulls reveal that blood flow rate to the brain increased faster than brain volume during human evolution’. R Soc Open Sci. 2017; 4: 170846 Crossref PubMed Scopus (5) Google Scholar Finely tuned physiological systems also maintain cerebral blood flow across a vast range of blood pressures to ensure blood delivery. It should not be surprising, therefore, that circulatory disorders strongly affect brain function, particularly hypertension. Prevalence of hypertension increases with age, as do stroke and Alzheimer's disease, and a study done in the USA showed that it is common to see both vascular and Alzheimer's disease pathologies present in brains of older individuals (median age 80 years) in the community. 2 Schneider JA Arvanitakis Z Bang W Bennett DA Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology. 2007; 69: 2197-2204 Crossref PubMed Scopus (1180) Google Scholar Moreover, validated Alzheimer's disease risk profiles include blood pressure along with other vascular risk factors, such as body-mass index and serum cholesterol concentrations. Life's Simple 7, a measure of healthy vascular lifestyle, is inversely associated with incident mild cognitive impairment, dementia, and preserved brain structure. 3 Thacker EL Gillett SR Wadley VG et al. The American Heart Association Life's Simple 7 and incident cognitive impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2014; 3: e000635 Crossref PubMed Scopus (90) Google Scholar Finally, the Systolic Blood Pressure Intervention Trial (SPRINT) MIND study 4 Williamson JD Pajewski NM et al. SPRINT MIND Investigators for the SPRINT Research GroupEffect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019; 321: 553-561 Crossref PubMed Scopus (493) Google Scholar conclusively showed that intensive treatment of hypertension was associated with a significant reduction in incident cognitive impairment. In that study, nearly 10 000 individuals were randomly assigned to standard (systolic blood pressure goal <140 mm Hg) or intensive (systolic blood pressure goal <120 mm Hg) blood pressure management. There was no substantial increase in side-effects with intensive treatment, even among older individuals (aged 75 years or older). Taken together, there is strong evidence that aggressive blood pressure management can mitigate dementia for at-risk older adults. Safety and efficacy of losartan for the reduction of brain atrophy in clinically diagnosed Alzheimer's disease (the RADAR trial): a double-blind, randomised, placebo-controlled, phase 2 trial12 months of treatment with losartan was well tolerated but was not effective in reducing the rate of brain atrophy in individuals with clinically diagnosed mild-to-moderate Alzheimer's disease. Further research is needed to assess the potential therapeutic benefit from earlier treatment in patients with milder cognitive impairment or from longer treatment periods. Full-Text PDF Open Access
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