Hypertension impairs cognitive function in middle-aged adults
Both prevalent and incident hypertension correlate with poorer global cognitive performance in middle-aged individuals, and this negative effect of hypertension on cognition appears to be true as well in younger patients with a short exposure to high blood pressure (BP), according to a new study.
“Moreover, our findings suggested that control of hypertension is of critical importance to prevent cognitive decline, especially in young newly diagnosed hypertensive patients,” researchers said. “This study is of great importance in the preservation of healthy cognitive ageing by emphasizing the need for early detection of hypertension and tight control of BP.”
At 10-year follow-up, patients with prevalent hypertension had poorer global cognitive function (for participants aged 32 or 42 years at baseline: β, −2.99±0.96; p=0.002; for participants aged 52 or 62 years: β, −5.94±1.00; p<0.001) than those without hypertension. Patients with incident hypertension also showed poorer cognitive function over time compared with nonhypertensive patients. [J Hypertens 2019;37:1244-1253]
Upon consideration of prevalent hypertension and BP control status by antihypertensive therapy, patients with untreated and uncontrolled hypertension were more likely to have poorer cognitive performances than those with controlled or no hypertension (untreated hypertension vs without hypertension: β, −5.51±0.75; p<0.001; uncontrolled hypertension vs without hypertension: β, −6.13±1.40; p<0.001).
These findings are consistent with those of two recent longitudinal studies, which provided evidence supporting the association between midlife hypertension and cognitive change. [J Am Geriatr Soc 2013;61:1489-1498; JAMA Neurol 2014;71:1218-1227]
Other studies reported that long-term hypertension could elevate arterial stiffness, leading to severe cerebral atherosclerosis and ischaemic conditions. [Lancet Neurol 2005;4:487-499; J Am Soc Hypertens 2012;6:309-315; Curr Hypertens Rep 2013;15:547-558; Am J Hypertens 2016;29:149-157]
“As suggested by our results, the first objective of treatment should be a BP goal <140/90 mm Hg in all patients but, provided that the treatment is well tolerated, lower BP thresholds and treatment targets should be considered according to patient's age and specific comorbidities in accordance with the 2018 ESC/ESH Guidelines for the management of arterial hypertension,” researchers said. [Hypertens 2018;36:1953-2041]
The current study followed 3,201 participants from the Vieillissement Santé Travail cohort study, aged 32, 42, 52 and 62 years at baseline, at 5 and 10 years later. Researchers assessed BP, antihypertensive medication use, and memory and speed cognitive performances at baseline and follow-up. Linear mixed models were used for analyses.
“[O]ur study highlighted the importance in hypertensive patients to pay particular attention to processing speed and executive functions when assessing cognitive performances,” researchers said. “The Montreal Cognitive Assessment … should be considered in clinical practice for detecting hypertension-associated cognitive impairment.” [J Am Geriatr Soc 2005;53:695-699]