Controlling Blood Pressure May Prevent Cognitive Decline

Controlling Blood Pressure May Help Prevent Cognitive Decline

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Consumer Reports has no financial relationship with advertisers on this site.

Research has long shown that controlling blood pressure—which affects more than than 100 million American adults—can help prevent strokes and heart attacks.

Now, new research published in JAMA reveals another benefit: Intensive blood pressure control may help lower chances of developing mild cognitive impairment (MCI), a condition that is often a precursor to dementia. People who tried to get their blood pressure lower than 120 mmHg systolic over 80 mmHg diastolic were 19 percent less likely to develop mild cognitive impairment than those who targeted getting their blood pressure under 140/90.

“What this shows is that what’s good for your heart as far as blood pressure control is good for your brain, too,” says study author Jeff Williamson, M.D., chief of geriatric medicine and gerontology at the Wake Forest School of Medicine in Winston-Salem, N.C.

But the study—which followed participants for about six years—didn’t find that aggressive blood pressure control reduced the risk of actual dementia during the study period, only MCI. And many people find that they can only bring their blood pressure down to under 120/80 with multiple medications, which have potentially dangerous side effects, such as an elevated risk of falling, says Steven Nissen, M.D., chair of cardiovascular medicine at the Cleveland Clinic.

Here’s how to make sense of this new research and determine which blood pressure goals are right for you.

What the Study Found

The researchers looked at 8,563 older adults who participated in the Systolic Blood Pressure Intervention Trial (SPRINT) study, which compared two strategies for managing high blood pressure in those already at risk for heart disease: an intensive strategy that tried to lower systolic blood pressure (the top number) to less than 120 mmHg, vs. a standard care strategy of less than 140 mmHg.

The original study, published in 2015 in the New England Journal of Medicine, found that the more intensive blood pressure control significantly lowered risk of major cardiovascular events such as heart attack, stroke, and heart failure.

In this newer study, called SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND), researchers examined whether the lower blood pressure target also lowered risk of developing dementia and/or MCI over the course of about six years.

The researchers found that people getting intensive treatment were 19 percent less likely to develop MCI over the course of the study compared with those getting the standard treatment. But while they were also less likely to develop dementia, that risk reduction wasn’t statistically significant.

“We think that’s because we weren’t following study participants long enough, and dementia takes a much longer time to show up than MCI,” Williamson says.

“I would not expect the lower blood pressure to affect an outcome like dementia in such a short period,” says Harlan Krumholz, M.D., a cardiologist and healthcare researcher at Yale-New Haven Hospital in Connecticut, who was not involved in the new study.

Williamson says he now recommends much more aggressive blood pressure treatment in all his patients because of his data. Other cardiologists are more cautious.

“As physicians are trying to treat patients with high blood pressure more aggressively based on the SPRINT trial, we’re seeing more side effects such as falls, too-low blood pressure, and kidney disease,” Nissen says. (In the SPRINT trial, 4.7 percent of patients getting intensive treatment experienced these types of serious side effects, compared with 2.5 percent in the standard group.)

What Patients Should Know

If you have hypertension (defined now by the American Heart Association as anything over 130/80), it’s crucial that you take steps to bring it under control, even if you’re relatively young, says Lon Schneider, M.D., director of the Alzheimer Disease Research Center at the University of Southern California in Los Angeles.

But it’s questionable whether you need to bring blood pressure to the levels targeted by the new study to reap results.

“Other studies have shown a significant reduction in dementia risk—about 13 percent—in adults over age 60 by simply bringing blood pressure down to under 150 mm systolic,” Schneider says. “The concern is if you try to treat to a specific number like 120/80, you’ll only end up with more adverse events.”

If your blood pressure is elevated (over 120/80) but not officially hypertension (130/80 or above), you should be especially cautious about rushing to medication.

The first step should be broad-based lifestyle changes, says Nissen, including weight loss (if necessary), regular exercise, and a heart-healthy diet. People who lose about 9 pounds can lower their blood pressure by almost 5 points, according to a recent Cochrane review.

And men and women with hypertension who exercised three times a week and followed the DASH diet (one rich in fruits, vegetables, and low-fat dairy) were able to lower their blood pressure on average 16 mmHg systolic and 10 mmHg diastolic without medication after 16 weeks, according to a University of North Carolina at Chapel Hill study presented last September at the American Heart Association’s annual meeting.

You should consider taking medication if you have stage two hypertension (which the AHA defines as anything over 140/90) and you haven’t been able to lower your blood pressure after two to three months of trying lifestyle changes. But talk to your doctor about what blood pressure target goal makes sense for you.

A young, otherwise healthy person in his or her 40s or 50s may want to try to get blood pressure down to 120/80, while an older individual at higher risk for falls may be better off with a more cautious approach, Nissen says.

“There’s no one-size-fits-all approach,” Nissen says. “Some patients, particularly older ones, may need to be on three or four blood pressure medications if they want to get their numbers down to 120/80, and ... in some cases, if someone is particularly frail, [that goal] may even be dangerous.”

If you’ve been on medication for a while and have gotten your blood pressure to target levels, consider talking to your doctor about lowering your dose, especially if you’ve lost weight and embraced a healthy diet and exercise. “All these things also reduce risk of dementia—without any side effects,” Schneider says.

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