Regularly aiming to keep blood pressure below 130/80 may benefit not just the heart. Heart Journal presented new evidence at this year’s European Society of Cardiology Congress showing that if you control your blood pressure this aggressively using diuretics and beta blockers (medical name: antihypertensives), you’ll be 15% less likely to develop dementia in this seven years. This gives credence to the hypothesis that protecting your arteries is also protecting your brain.. Dementia is still one of the most dreaded health consequences of growing older.
Although age and genetics are most significant, investigators have searched for years for “treatable risk factors” that may make it possible to slow or halt cognitive deterioration. High blood pressure has been on that group for years. Excess pressure puts strain on blood vessels all over the body, in particular the tiny ones that serve the brain.
With time, that stress can result in the vascular deterioration and decreased blood flow that are hallmarks of some types of dementia. The most recent review reinforces this argument from the other side. Those patients whose BP was treated more intensively, with goal levels below 130/80, gained long-term benefit in brain health compared to those whose treatment sought to lower to higher levels.
A 15 percent relative risk reduction over seven years is not a solution, but it is a real gain from a management strategy that nearly all patients and physicians are already employing: this is a practical finding, because the management of blood pressure is now business as usual. There are many effective medicines, changes in lifestyle and protocols for regular re-measurement. The findings appear to show that the reduction towards the lower target may have additional benefits beyond that of preventing a thrombo-emoblic event.
For middle aged and the older adult, mainly if they have known hypertension, there is one more reason to adhere to treatment and for patient-doctor consultation on a target number to be made clear. It does not suggest that intensive control can totally prevent dementia. Dementia results from multifactorial processes that are impossible to modify through any one risk factor. A 15 percent reduction on the population basis still involves many individuals who would have developed dementia can be spared or delayed cognitive decline.
As many public health specialists point out, even small relative risk reductions often means large absolute reductions when the disease is common. Clinicians at the congress also reiterated that the benefits seemed to be similar for various groups of patients. The findings complement the previous observations and smaller trials that suggested similar results.
And, the results also correspond with the accumulating evidence suggesting that midlife vascular health solidly impacts brain function in later life. It might be some of the best ways to preserve cognitive health for decades to come. Tighter control needs to be done with caution. Where blood pressure medication may have adverse reactions for some patients others may not tolerate a too aggressive approachcausing dizziness or falls in the older person. Making treatment individualized rather than universally applying one target is the desired solution. Weighing up the potential benefit of better brain health compared to other issues of each individual and ongoing monitoring and discussion is still the way to go.