Untreated High Blood Pressure, Regardless of Age or Duration, Negatively Impacts Cognitive Health

Sandhi M. Barreto, MD, MSc, PhD

While previous research has linked high blood pressure in aging patients to an increased risk of accelerated cognitive decline later in life, a new study is diving deeper and suggests hypertension at any point in life could be detrimental to the mental health of patients as they age.

Results of the study indicated untreated hypertension at any age was associated with declines in cognitive performance regardless of hypertension duration and uncontrolled hypertension appeared to pose the greatest risk to patients.

“Our results show similar accelerated cognitive performance decline whether hypertension started in middle age or at older ages,” said lead investigator Sandhi M. Barreto, MD, MSc, PhD, professor of medicine at the Universidade Federal de Minas Gerais in Belo Horizonte, Brazil, in a statement from the American Heart Association. “We also found that effectively treating high blood pressure at any age in adulthood could reduce or prevent this acceleration. Collectively, the findings suggest hypertension needs to be prevented, diagnosed and effectively treated in adults of any age to preserve cognitive function.”

To further explore the relationship between hypertension and prehypertension with accelerated cognitive decline in aging patients, investigators designed the current study as an assessment of cognitive performance of patients in the ELSA-Brasil cohort. A longitudinal study of adult patients from 6 regions in Brazil, ELSA-Brasil provided investigators with data related to a cohort of more than 15,000 patients. Only using patients with data related to cognitive performance at baseline and the second study visit, which occurred approximately 4 years after enrollment, investigators identified a group of 7063 patients for inclusion in the current study.

Cognitive performance of all these patients as measured and evaluated using memory, verbal fluency, trail B tests, and a global cognitive score. For the purpose of analysis, a systolic blood pressure of 120 mmHg or greater and a diastolic blood pressure of 80 mmHg or greater and no antihypertensive medication used was used as the criteria to define prehypertension. Hypertension was defined as a systolic blood pressure of 140 mmHg or greater or diastolic blood pressure of 90 mmHg or greater and use of antihypertensive medication.

The mean age of the 7063-patient cohort was 58.9 years at visit 1, 15.3% of participants were Black, and 53.4% spent 14 years or longer enrolled in the study. The mean time between first and second visit of the study was 3.8 (1.7-6.0) years. Overall, 22% of patients had prehypertension and 46.8% were considered hypertensive. Among those with hypertension, 29.8% were diagnosed at middle age and the median duration of hypertension was 7.0 (IQR, 1-15) years. Investigators also noted 7.3% of patients did not use an antihypertensive medication and 31.2% of those receiving antihypertensive medications had uncontrolled blood pressure levels.

In linear mixed models, investigators found hypertension and prehypertension at baseline were associated with declines in global cognitive score. These models also indicated hypertension was associated with reduction in memory test scores and prehypertension was associated with reductions in fluency test scores. When assessing timing of hypertension diagnoses, investigators founded diagnoses at 55 years or older were associated with lower global cognitive and memory test scores while diagnoses before the age of 55 were associated with lower memory test scores.

Further analysis indicated the duration of hypertension diagnoses was not associated with any of the study markers of cognitive decline. Additionally, results of the investigators' analyses indicated blood pressure control at baseline was inversely associated with declines in both global cognitive and memory test scores.

“In addition to other proven benefits of blood pressure control, our results highlight the importance of diagnosing and controlling hypertension in patients of any age to prevent or slow down cognitive decline,” Barreto said in the aforementioned statement. “Our results also reinforce the need to maintain lower blood pressure levels throughout life, since even prehypertension levels were associated with cognitive decline.”

This study, “Hypertension, Prehypertension, and Hypertension Control Association With Decline in Cognitive Performance in the ELSA-Brasil Cohort,” was published in Hypertension.