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      Defining the relationship between hypertension, cognitive decline, and dementia: a review

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          Abstract

          Hypertension is a highly prevalent condition which has been established as a risk factor for cardiovascular and cerebrovascular disease. Although the understanding of the relationship between cardiocirculatory dysfunction and brain health has improved significantly over the last several decades, it is still unclear whether hypertension constitutes a potentially treatable risk factor for cognitive decline and dementia. While it is clear that hypertension can affect brain structure and function, recent findings suggest that the associations between blood pressure and brain health are complex and, in many cases, dependent on factors such as age, hypertension chronicity, and antihypertensive medication use. Whereas large epidemiological studies have demonstrated a consistent association between high midlife BP and late-life cognitive decline and incident dementia, associations between late-life blood pressure and cognition have been less consistent. Recent evidence suggests that hypertension may promote alterations in brain structure and function through a process of cerebral vessel remodeling, which can lead to disruptions in cerebral autoregulation, reductions in cerebral perfusion, and limit the brain’s ability to clear potentially harmful proteins such as β-amyloid. The purpose of the current review is to synthesize recent findings from epidemiological, neuroimaging, physiological, genetic, and translational research to provide an overview of what is currently known about the association between blood pressure and cognitive function across the lifespan. In doing so, the current review also discusses the results of recent randomized controlled trials of antihypertensive therapy to reduce cognitive decline, highlights several methodological limitations, and provides recommendations for future clinical trial design.

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          Author and article information

          Journal
          100888982
          21831
          Curr Hypertens Rep
          Curr. Hypertens. Rep.
          Current hypertension reports
          1522-6417
          1534-3111
          20 September 2018
          March 2017
          30 September 2018
          : 19
          : 3
          : 24
          Affiliations
          [1 ]Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
          [2 ]Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
          [3 ]Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
          Author notes
          Corresponding Author: Rebecca F. Gottesman, rgottesm@ 123456jhmi.edu , Department of Neurology, Johns Hopkins Hospital, Phipps 446D, 600 North Wolfe St., Baltimore, MD 21287, T: 410-614-2381, F: 410-955-0672
          Article
          PMC6164165 PMC6164165 6164165 nihpa989009
          10.1007/s11906-017-0724-3
          6164165
          28299725
          905be857-8649-4146-be1c-fb89ca2ef1e7
          History
          Categories
          Article

          Hypotension,Dementia,Cognitive Impairment,Cognition,Blood Pressure,Hypertension

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