Hypertension and cognition: managing blood pressure to protect the brain

Author: Juliana Ferreira | Editor: Laure Pauly, Anja Leist

Hypertension, high blood pressure, is when the pressure in your blood vessels is too high. It is often called the ‘silent killer,’ as it is a serious global health issue. In 2024, it affected about 1.4 billion adults aged 30–79 worldwide, but only around 320 million were treated for it.¹ High blood pressure doesn’t just harm the heart, it also increases the risk of cognitive decline and dementia, making blood pressure management essential for brain health. ^2,3

How do I know that I have hypertension?

Hypertension is often asymptomatic, meaning that most people with hypertension don’t feel any symptoms.  Which is why it is very important to monitor your blood pressure using automated devices and consult your doctor regularly. Blood pressure over 140/90 mmHg is considered as hypertension.¹  Extremely high blood pressure can however cause headaches, blurred vision, dizziness, nausea, anxiety, nosebleeds or chest pain. If you should experience any of these symptoms, seek care immediately.

Does hypertension affect how our brain works?

Yes, high blood pressure can have harmful effects on the brain.^2,3 It is an important risk factor for vascular cognitive impairment and late-life dementia⁴. When the pressure of the circulating blood is continuously too high, the brain’s smaller blood vessels become thinner and damaged. This damage impairs the brain’s ability to clear substances that are toxic to it, and as a result, their entry and accumulation harm brain function.^3,5

Can I prevent hypertension?

Genetic factors and aging are non-modifiable risk factors for hypertension. However, modifiable lifestyle factors, such as excess body weight, physical inactivity, excessive alcohol consumption, smoking, and a high-salt diet, can be addressed to help prevent hypertension.¹ Maintaining healthy lifestyle factors can reduce blood pressure regardless of genetic susceptibility to hypertension.

Age

The blood vessels in the brain have the ability to contract and dilate in response to changes in blood pressure. This mechanism helps regulate cerebral blood flow velocity and protects the brain. However, as we age, this ability to contract and dilate becomes less effective, and the vessels do not respond as well. If high blood pressure persists, this impaired response can negatively affect brain function.⁵ Therefore, regular blood pressure monitoring and medical follow-up are essential strategies for the early detection and management of age-related changes in blood pressure.

Excess body weight and physical inactivity

Weekly physical activity has been shown to reduce blood pressure, especially when totaling two hours and thirty minutes or more per week. Previous studies have found that people who engage in aerobic exercises, such as walking or cycling, experience a decrease in blood pressure⁶. 

In addition to lowering blood pressure, physical activity can also support initial weight loss and help maintain it over time. This contributes to reducing the pressure exerted on the arteries and, consequently, to lowering blood pressure.

In the process of weight loss and maintenance, diet plays a crucial role. There are changes we can make to our eating habits that help maintain a healthy weight and, when combined, can have a direct impact on blood pressure.

What can we change?

Avoid diets primarily composed of meat, fat, and starch, foods that are known to be unfavorable for lowering blood pressure. Instead, we can: Reduce daily fat intake; Consume at least 30 grams of fiber per day and choose healthier sources of protein, such as fish, skinless poultry, and soy-based products.⁷

• Low-salt diet – Eating less salt, up to about 1 teaspoon or 3.5 grams per day,  can help lower blood pressure. Clinical trials are consistent in showing the impact of excessive salt intake on blood pressure. Reducing salt in the diet lowers blood pressure both in people with hypertension and in those with blood pressure within the recommended range, and it can be a helpful addition to medication-based treatments for hypertension.⁷
  
• Avoiding alcohol consumption and smoking. Light to moderate alcohol consumption appears to have no effect on blood pressure, but excessive consumption can cause blood vessel constriction, making it harder for blood to circulate. Therefore, moderate consumption is recommended. The same applies to smoking: smoking increases cardiac output and total peripheral vascular resistance, meaning that the heart works harder while the blood vessels become narrower. This difficulty in blood circulation leads to an increase in blood pressure.⁷

What if I already have hypertension?

If you’ve already been diagnosed with hypertension, it’s important to know that you can still take steps to protect your brain and improve your health. Lifestyle changes, such as reducing salt intake, increasing physical activity, quitting smoking, and managing stress, can significantly lower blood pressure and reduce the risk of brain-related complications. In addition, medical treatment is often necessary. Your doctor may prescribe antihypertensive medications to help control your blood pressure. These treatments are effective and, when combined with healthy habits, can slow or even reverse some of the damage caused by high blood pressure. Regular follow-up and adherence to your treatment plan are key to maintaining both cardiovascular and brain health.

Conclusion

What can we do to reduce the risk for hypertension and, consequently, protect our brain?

• Monitor your blood pressure and consult your doctor regularly.
• Reduce the intake of salt and fats.
• Engage in regular physical activity.
• Quit smoking (or don’t even start).
• Decrease alcohol consumption.
• Manage stress.
• Maintain a healthy body weight. 

These measures, when taken together, can have a significant impact on your blood pressure and, consequently, on your brain health.

For better readability of the text, the assistance of Microsoft Copilot, an AI language model based on the GPT-4 architecture, secured with UL enterprise data protection, has been used.

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