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Editorial |

Blood Pressure and the Prevention of Cognitive Impairment

Philip B. Gorelick, MD, MPH1,2
[+] Author Affiliations
1Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan
2Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids
JAMA Neurol. 2014;71(10):1211-1213. doi:10.1001/jamaneurol.2014.2014.
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Hypertension affects more than two-thirds of US adults 60 years or older,1 and control is considered by some to be the “crown jewel” of stroke prevention. Despite mounting epidemiologic and mechanistic evidence linking raised blood pressure (BP) to cognitive decline or dementia, uncertainty remains about the benefit of lowering BP to prevent cognitive impairment.2,3 Recent estimates suggest, for example, that 8% of cases of Alzheimer disease (AD) may be attributable to midlife hypertension, and the relative risk for midlife hypertension in AD is 1.6. Furthermore, multiple potential mechanisms link hypertension to cognitive compromise as we age.46 Mechanistic endothelial dysfunction or vascular dysregulation, oxidative stress, and inflammation may interrupt vital homeostatic functions, resulting in structural brain and cognitive consequences.5,6 Of further interest, epidemiologic evidence suggests a declining prevalence of dementia7 that may be explained at least in part by better control of cardiovascular risk factors over time. However, in a recently reported study among patients with type 2 diabetes mellitus, the Memory in Diabetes substudy of the Action to Control Cardiovascular Risk in Diabetes Trial (MIND ACCORD), intensive BP-lowering therapy (systolic BP [SBP], <120 mm Hg) plus fibrate therapy vs standard therapy (SBP, <140 mm Hg) in the presence of controlled low-density lipoprotein cholesterol levels did not result in a measurable effect on cognitive decline after 40 months of follow-up.8

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