Pathophysiology of Cognitive Decline and Dementia in Hypertension

Vascular dementia is the second cause of dementia after Alzheimer’s disease. Dementia is strongly associated with age, but also with vascular risk factors, particularly hypertension which play an important role in the pathophysiology of cognitive impairment and dementia. There are synergistic deleterious effects of sustained elevated blood pressure and old age on the structural and functional integrity of the cerebral microcirculation and cognitive function. Hypertension promotes the development of atherosclerotic plaques in carotid arteries, vertebral and intracranial cerebral arteries, cerebral small vessel disease, endothelial dysfunction; and also hypertension is the main risk factor for stroke which may lead to development of dementia. This chapter reviews the pathogenic mechanisms of structural and functional alterations induced by hypertension and associated cardiovascular risk factors on small brain vessels leading to cognitive impairment and dementia.