Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association
Open accessAbstract
Background—: Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. Methods—: Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. Results—: Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. Conclusions—: After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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Vascular risk factors including hypertension, diabetes, hyperlipidemia, and cardiovascular disease, as well as environment and lifestyle, all affect cerebrovascular and BBB dysfunction.
“Vascular risk factors including hypertension (169, 272), diabetes (43, 110), hyperlipidemia (74), and cardiovascular disease (594), as well as environment (e.g., pollution) (87-89, 207) and lifestyle (e.g., obesity, sedentary lifestyle) (281, 643) all affect cerebrovascular and BBB dysfunction (429, 571), and may influence onset and progression of AD.”
From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [272]
The Blood-Brain Barrier and Vascular Function sections (page not provided) report that hypertension disrupts BBB integrity and cerebrovascular function. The source discusses other risk factors in relation to cognition, but these passages do not establish that diabetes, hyperlipidemia, cardiovascular disease, pollution, obesity, and sedentary lifestyle all cause cerebrovascular and BBB dysfunction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEvidence suggests that midlife may be a critical period when exposure to high blood pressure is likely to increase risk of poorer cognition in late life.
“The evidence suggests that midlife may represent a critical period when exposure to high blood pressure is likely to increase risk of poorer cognition in late-life (8).”
From Oversimplification of Dementia Risk Reduction Messaging Is a Threat to Knowledge Translation in Dementia Prevention Research (2018) · cites this paper as [8]
Few trials of antihypertensive agents have included cognitive outcomes.
“Few trials of antihypertensive agents have included cognitive outcomes and each trial has, almost inevitably, focused on a differing population group and used differing treatment regimens, inclusion criteria, blood pressure targets and in general relatively short follow up (8).”
From Oversimplification of Dementia Risk Reduction Messaging Is a Threat to Knowledge Translation in Dementia Prevention Research (2018) · cites this paper as [8]
There is emerging evidence for taking a life-course approach to exposure because it may account for varying exposure levels over time.
“There is now also emerging evidence for taking a life-course approach to exposure not least as the latter may take account of varying exposure levels over time (8, 9, 10).”
From Oversimplification of Dementia Risk Reduction Messaging Is a Threat to Knowledge Translation in Dementia Prevention Research (2018) · cites this paper as [8]
Antihypertensive trials have differed in population group, treatment regimens, inclusion criteria, blood pressure targets, and follow-up length.
“Few trials of antihypertensive agents have included cognitive outcomes and each trial has, almost inevitably, focused on a differing population group and used differing treatment regimens, inclusion criteria, blood pressure targets and in general relatively short follow up (8).”
From Oversimplification of Dementia Risk Reduction Messaging Is a Threat to Knowledge Translation in Dementia Prevention Research (2018) · cites this paper as [8]
Cardiovascular risk factors are closely associated with cognitive impairment and dementia.
“Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia.”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [5]
A more contemporary scientific statement found inconclusive evidence that blood pressure control preserves cognition in the population at large.
“A more contemporary scientific statement found inconclusive evidence that BP control preserves cognition in the population at-large.5”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [5]
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Protecting against vascular disease in brain
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Relationship Between White Matter Hyperintensities, Cortical Thickness, and Cognition
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Self-citationPulse wave velocity is associated with β-amyloid deposition in the brains of very elderly adults
Hughes, T. M., Kuller, L. H., Barinas-Mitchell, E. J. M., Mackey, R. H., McDade, E. M., Klunk, W. E., Aizenstein, H. J., Cohen, A. D., Snitz, B. E., Mathis, C. A., et al. (2013) · Neurology · doi:10.1212/01.wnl.0000435301.64776.37 · Cited by 190 · see citing works
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Muller, M., van der Graaf, Y., Visseren, F. L. J., Mali, W. P. T. M., Geerlings, M. I., & for the SMART Study Group (2012) · Annals of Neurology · doi:10.1002/ana.23554 · Cited by 186 · see citing works
Systolic Blood Pressure Tracking Over 25 to 30 Years and Cognitive Performance in Older Adults
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Interaction Between Hypertension, apoE, and Cerebral White Matter Lesions
de Leeuw, F., Richard, F., de Groot, J. C., van Duijn, C. M., Albert Hofman, D., van Gijn, J., & Breteler, M. M. B. (2004) · Stroke · doi:10.1161/01.str.0000125859.71051.83 · Cited by 184 · see citing works
Blood pressure levels and brain volume reduction
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Blood Pressure-Related Cognitive Decline
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Reducing the Risk of Dementia: Efficacy of Long-Term Treatment of Hypertension
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Self-citationAPOE genotype and MRI markers of cerebrovascular disease
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Self-citationHigh Blood Pressure in Children and Adolescents
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- [89]Lezak M Neuropsychological Assessment New York, NY Oxford University Press 2004
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2018 ESC/ESH Guidelines for the management of arterial hypertension
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Blood-Brain Barrier: From Physiology to Disease and Back
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Hypertension-induced cognitive impairment: From pathophysiology to public health
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Self-citationSolid Lipid Nanoparticles (SLNs): An Advanced Drug Delivery System Targeting Brain through BBB
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Blood Pressure Variability and Progression of Clinical Alzheimer Disease
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A review of the mechanisms underlying selected comorbidities in Alzheimer’s disease
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“Few trials of antihypertensive agents have included cognitive outcomes and each trial has, almost inevitably, focused on a differing population group and used differing treatment regimens, inclusion criteria, blood pressure targets and in general relatively short follow up (8).”
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- Authors
- Iadecola, C., Yaffe, K., Biller, J., Bratzke, L. C., Faraci, F. M., Gorelick, P. B., Gulati, M., Kamel, H., Knopman, D. S., Launer, L. J., Saczynski, J. S., Seshadri, S., & Zeki Al Hazzouri, A.
- ORCID
- Venue
- Hypertension
- Published
- 2016-12
- Volume
- 68
- Issue
- 6
- Pages
- e67-e94
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC5361411
- OpenAlex
- W2530115453
- Semantic Scholar
- 1f0aaa0710148c9974472c023c1134b92f24307f
- Cited by
- 746
- References
- 334
- Citations by year
- 2026: 61 · 2025: 68 · 2024: 78 · 2023: 79 · 2022: 77 · 2021: 85 · 2020: 93 · 2019: 95 · 2018: 64 · 2017: 42 · 2016: 1
- FWCI
- 59.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (P30AG010129, K01AG047273)
- National Institute of Neurological Disorders and Stroke (R37NS089323, R01NS017950)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- cognitive function, dementia, Alzheimer's disease, vascular dementia, white matter ischemia, cerebral vasculature, antihypertensive therapy, midlife hypertension, cerebrovascular injury, brain health
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Alzheimer Disease, American Heart Association, Antihypertensive Agents, Cognition Disorders, Female, Follow-Up Studies, Humans, Hypertension, Male, Severity of Illness Index, Sex Factors, United States, Dementia, Vascular, Practice Guidelines as Topic, Disease Progression, Risk Assessment, Evidence-Based Medicine
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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