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  • Review Article
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The relationship between blood pressure and cognitive function

Abstract

The relationship between blood pressure (BP) and cognitive outcomes in elderly adults has implications for global health care. Both hypertension and hypotension affect brain perfusion and worsen cognitive outcomes. The presence of hypertension and other vascular risk factors has been associated with decreased performance in executive function and attention tests. Cerebrovascular reserve has emerged as a potential biomarker for monitoring pressure–perfusion–cognition relationships. A decline in vascular reserve capacity can lead to impaired neurovascular coupling and decreased cognitive ability. Endothelial dysfunction, microvascular disease, and mascrovascular disease in midlife could also have an important role in the manifestations and severity of multiple medical conditions underlying cognitive decline late in life. However, questions remain about the role of antihypertensive therapies for long-term prevention of cognitive decline. In this Review, we address the underlying pathophysiology and the existing evidence supporting the role of vascular factors in late-life cognitive decline.

Key Points

  • Hypertension and hypotension affect neurovascular coupling, leading to a decrease in perfusion, oxygenation, and vascular reserve capacity, and are associated with microvascular disease, stroke, cognitive function decline, and dementia

  • Risk factors for vascular disease accelerate age-related decline in perfusion and brain tissue volumes and have additive effects in worsening cognitive outcomes late in life

  • Hypertension and other vascular risk factors are linked to poorer performance in executive function and attention tests than in memory or language scores

  • Results of antihypertensive treatment in trials for prevention of dementia in the elderly remain inconclusive, but some studies indicate that single-drug or combined antihypertensive therapies have protective effects on cognition

  • More research is needed to determine which blood pressure values should be targeted to optimize perfusion and to prevent cognitive decline in the elderly

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Figure 1
Figure 2: Relationship between arterial BP and BFV in the middle cerebral artery.
Figure 3: Anatomical and perfusion images from a patient with hypertension and diabetes mellitus and an age-matched healthy control.
Figure 4: High resolution 8-T gradient gadolinium-enhanced echography slices (in-plane pixel size 195 μm).

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Acknowledgements

V. Novak was supported by grants 1R01AG028076-A2 and 1P01AG028717-01A2 from the National Institute on Aging, NIH and by grant 1R21DK084463-01A1 from the National Institute of Diabetes and Digestive and Kidney Diseases, NIH. I. Hajjar was supported by grant K23AG030057 from the National Institute on Aging, NIH. Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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V. Novak and I. Hajjar contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Novak, V., Hajjar, I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol 7, 686–698 (2010). https://doi.org/10.1038/nrcardio.2010.161

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