How to Prevent Cognitive Decline and Dementia in Hypertension

A large body of evidence supports a close relationship between high blood pressure in middle age and the risk of cognitive impairment and dementia in the elderly. This is important because hypertension is the most prevalent cardiovascular risk factor in the world and the leading risk factor for global disease burden. On the other hand, neurological disorders are leading cause of disability-adjusted life-years and the second cause of death. In particular, Alzheimer’s disease and related dementias are the fifth leading cause of death globally. Given the projected trends in population ageing, growth, and survival, the number of people with dementia is expected to increase from 57 million cases globally in 2019 to 153 million cases in 2050, leading to a huge public health problem in all countries. Therefore, interventions addressed to modify and control risk factors such as hypertension will be key in reducing the expected increase in the number of individuals affected by dementia in the near future. The answer to the question whether is it possible to stop or delay the onset and progression of cognitive impairment and dementia by reducing blood pressure levels in patients with hypertension seems crucial. This chapter reviews the studies showing that antihypertensive treatment can modify the pathophysiology of the natural history of cognitive impairment in hypertensive patients, and delay the progression of mild cognitive decline towards dementia in many of these patients. Finally, in addition to the blood pressure targets to be achieved to optimize the treatment effect in reducing the incidence of dementia, results from recent analysis of randomized clinical trials showing that some antihypertensive drugs and strategies are more effective than others are discussed.