Cited by 544Neurological Disease Mechanisms and TreatmentsDementia and Cognitive Impairment ResearchCerebrovascular and genetic disorders

Hypertension-induced cognitive impairment: From pathophysiology to public health

Open access
Ungvari, Zoltan, Toth, Peter, Tarantini, Stefano, Prodan, Calin I., Sorond, Farzaneh, Merkely, Bela, Csiszar, Anna·2021·Nature Reviews Nephrology

Abstract

Hypertension affects two-thirds of people aged >60 years and significantly increases the risk of both vascular cognitive impairment and Alzheimer's disease. Hypertension compromises the structural and functional integrity of the cerebral microcirculation, promoting microvascular rarefaction, cerebromicrovascular endothelial dysfunction and neurovascular uncoupling, which impair cerebral blood supply. In addition, hypertension disrupts the blood-brain barrier, promoting neuroinflammation and exacerbation of amyloid pathologies. Ageing is characterized by multifaceted homeostatic dysfunction and impaired cellular stress resilience, which exacerbate the deleterious cerebromicrovascular effects of hypertension. Neuroradiological markers of hypertension-induced cerebral small vessel disease include white matter hyperintensities, lacunar infarcts and microhaemorrhages, all of which are associated with cognitive decline. Use of pharmaceutical and lifestyle interventions that reduce blood pressure, in combination with treatments that promote microvascular health, have the potential to prevent or delay the pathogenesis of vascular cognitive impairment and Alzheimer's disease in patients with hypertension.

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  • Oxidative microvascular damage and BBB disruption caused by hypertension could worsen the progression of AD.

    “This oxidative microvascular damage and BBB disruption caused by hypertension could worsen the progression of AD [86].”
  • Hypertension in older adults leads to maladaptation of the cerebral circulation, causing disruption in the blood-brain barrier and oxidative stress.

    “Hypertension in older adults leads to maladaptation of the cerebral circulation, causing a disruption in the blood–brain barrier (BBB) and oxidative stress [86].”

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Research works printed but not linked: 1

  1. [117]Ungvari Z Tarantini S Kirkpatrick AC Csiszar A Prodan CI Cerebral microhemorrhages: mechanisms, consequences and prevention Am. J. Physiol. Heart Circ. Physiol. 2017 312 H1128 H1143 10.1152/ajpheart.00780.2016 28314762 PMC5495931 · DOI

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Authors
Ungvari, Z., Toth, P., Tarantini, S., Prodan, C. I., Sorond, F., Merkely, B., & Csiszar, A.
Affiliations
  • Semmelweis University (HU)
  • Northwestern University (US)
Venue
Nature Reviews Nephrology
Published
2021-06-14
Volume
17
Issue
10
Pages
639-654
ISSN
  • 1745-8323 (ISSN-L)
  • 1759-5061
  • 1759-507X
OpenAlex
W3166921190
Cited by
544
References
193
Citations by year
2026: 77 · 2025: 123 · 2024: 146 · 2023: 116 · 2022: 67 · 2021: 15
FWCI
10.17
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Nephrology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Veterans Affairs (I01 CX000340, CX000340)
  • American Heart Association
  • Presbyterian Health Foundation
  • Oklahoma Center for the Advancement of Science and Technology
  • National Institute on Aging (RF1AG072295, R01AG068295, R01AG055395)
  • National Institute of Neurological Disorders and Stroke (RF1NS085002)
Topics
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
Keywords
hypertension, cognitive impairment, vascular cognitive impairment, Alzheimer's disease, cerebral microcirculation, neurovascular uncoupling, blood-brain barrier, neuroinflammation, amyloid pathology, aging, white matter hyperintensities, lacunar infarction, cerebral small vessel disease, blood pressure reduction, lifestyle intervention
MeSH terms
Alzheimer Disease, Humans, Hypertension, Public Health, Cognitive Dysfunction

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