According to the World Health Organization, approximately 46% of the 1.28 billion adults worldwide with high blood pressure are unaware of their condition. However, living with uncontrolled hypertension can significantly elevate the risk of Alzheimer’s disease in people aged 60 and older, according to a recent meta-analysis.
The study found that individuals with untreated high blood pressure had a 36% higher risk of developing Alzheimer’s compared to those without hypertension. Furthermore, their risk was 42% higher than those who were managing their blood pressure with medication.
Additionally, untreated high blood pressure was associated with a 69% higher risk of non-Alzheimer’s dementias, such as vascular dementia, compared to people without hypertension. People with medicated but poorly controlled hypertension still had a 33% higher risk of these other dementias, Lennon explained. However, when blood pressure was effectively managed through medication, the elevated risk for non-Alzheimer’s dementia disappeared.
Unfortunately, many individuals with diagnosed hypertension do not consistently take their medications or struggle with treatment-resistant hypertension. According to the WHO, only about 1 in 5 adults have their blood pressure under control. “The statistics on blood pressure are alarming,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, who was not involved in the study.
“It’s a highly potent risk factor that often goes overlooked or mismanaged.”
He added that focusing solely on the heart overlooks the broader impact of high blood pressure. “A coronary event affects the entire body,” Freeman said. “Blood vessel disease can occur anywhere, including the brain and peripheral areas.” Uncontrolled hypertension has long been linked to an increased risk of kidney disease, stroke, type 2 diabetes, dementia, and heart disease, noted Dr. Richard Isaacson, a preventive neurologist, and director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida.
While the buildup of beta-amyloid plaques and tau tangles are believed to be central to Alzheimer’s disease, unchecked chronic conditions like high blood pressure, cholesterol, and diabetes can fuel brain inflammation, said Isaacson, who was also not involved in the study. “These vascular risk factors may not directly cause Alzheimer’s but can accelerate its progression and increase overall risk,” Isaacson said.
A worldwide perspective on the connection between blood pressure and dementia.
The meta-analysis, published Wednesday in the journal *Neurology*, reviewed four years of data from over 31,000 participants, with an average age of 72, across 14 countries: Australia, Brazil, China, France, Germany, the Republic of Congo, Spain, Sweden, and the United States.
The study found no significant differences in the relationship between blood pressure control and increased Alzheimer’s risk across different sexes or racial groups. “This is an encouraging finding, as it implies that effective care for one group may also benefit others,” said Dr. Matthew Lennon. He emphasized the importance of promoting chronic illness management in developing countries, where such conditions are less understood but are expected to drive the majority of new dementia cases in the coming years.
According to the analysis, untreated high blood pressure was linked to a 110% higher risk of vascular dementia—the second most common form of dementia after Alzheimer’s—compared to those without hypertension, and a 71% higher risk compared to those with treated high blood pressure. However, Lennon noted that these findings did not reach statistical significance due to the small sample size and adjustments for confounding factors.
Nonetheless, numerous studies have established that hypertension damages small blood vessels and reduces blood flow to the brain.
The analysis also revealed a U-shaped relationship between Alzheimer’s risk and blood pressure, influenced by age, making it difficult to apply a universal approach to treatment, explained Dr. Richard Isaacson. “The challenge in setting blood pressure targets for dementia or Alzheimer’s prevention lies in this U-shaped curve: blood pressure that’s too low may increase risk, and blood pressure that’s too high also increases risk,” he said.
Isaacson recommended general targets for blood pressure management, with systolic (the top number) in the low 120s or below, and diastolic (the bottom number) in the low 70s or below. However, he advised that these numbers should be personalized based on individual consultations with a healthcare provider.
How to take charge of your blood pressure
Experts emphasize that you can significantly reduce your risk of Alzheimer’s and other chronic conditions related to uncontrolled hypertension by taking preventive measures.
Monitor your blood pressure regularly: A single reading won’t give an accurate picture since blood pressure can fluctuate throughout the day. Instead, take multiple readings at the same time each day over several days, says Dr. Andrew Freeman. The American Heart Association (AHA) recommends this approach to track how your blood pressure trends.
Choose the right equipment: The AHA advises using a validated, automatic, cuff-style monitor for the upper arm, as wrist and finger monitors tend to be less reliable. “If you’re unsure which monitor to choose, ask your healthcare provider or check validated options at validatebp.org,” the AHA suggests. Monitors with memory tracking are helpful, but you can also keep a journal to record your readings.
Follow proper procedures: Before measuring your blood pressure, avoid smoking, drinking caffeinated beverages, or exercising for at least 30 minutes, advises the AHA. Empty your bladder and sit with your back supported in a chair, not on a sofa. Keep your feet flat on the floor and your arm at heart level on a table. It’s also recommended to occasionally check the pressure in both arms, as a difference in readings may signal an increased risk for heart attack or stroke.
Take your blood pressure medication daily: Many people fail to take their medication as prescribed, which can severely impact blood pressure control. “These drugs often have short half-lives, so it’s critical to take them consistently,” says Dr. Richard Isaacson. To ensure adherence, use a pill organizer with the days of the week labeled, so it’s clear if you miss a dose. Dr. Freeman adds that many people unintentionally skip doses when they don’t track them properly.
Make lifestyle changes: Diet plays a crucial role in managing hypertension. Diets rich in fruits, vegetables, whole grains, and healthy fats, while limiting sodium, can make a significant difference. The DASH diet, which emphasizes reducing salt intake to 2,300 milligrams per day, is a well-researched method for lowering blood pressure. However, the AHA recommends aiming for less than 1,500 milligrams per day.
Cutting salt intake by 2,300 milligrams (about one teaspoon) daily for a week can lower your systolic blood pressure as much as hypertension medication, according to a 2023 study.
Exercise regularly: Consistent exercise is one of the most effective treatments for high blood pressure. Pair this with stress relief, a healthy diet, and quality sleep, ad many people can achieve well-controlled blood pressure with less or even no medication. As always, consult your doctor before starting any exercise regimen.
