Have High Blood Pressure? Intensive Treatment May Reduce Risk for Dementia

Nearly half of American adults have high blood pressure. This is a major concern: High blood pressure raises the risk for heart attack, heart failure and stroke. Unfortunately, most people don’t realize they have high blood pressure. It’s known as the “silent killer” because there are seldom symptoms. 

But those aren’t the only problem for people with hypertension. High blood pressure in mid-life is a key risk factor for developing dementia, particularly vascular dementia, later in life, according to the Alzheimer’s Organization. 

However, if you have high blood pressure, intensive control of it can lower risks for heart disease complications and dementia and may have another benefit: It can improve your brain structure, according to a study funded by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health and presented at the 2023 American Stroke Association International Stroke Conference. 

“This is the first study to look at the possibility that blood pressure treatment could slow, even reverse structural changes to the brain, particularly perivascular spaces. These are spaces around the blood vessels of the brain that are involved in clearing toxins and byproducts from the brain,” says Bernard Kaminetsky, MD, medical director, MDVIP. “Enlarged perivascular spaces have been linked to aging and heart disease risk.”

The study began with researchers analyzing brain scans from 658 participants enrolled in the SPRINT-MIND trial sub-study that ran between 2010 and 2016. The average age of participants was 67. Sixty percent were women. All of them had high blood pressure, but none of them had either type 1 or type 2 diabetes, dementia or a history of stroke.

After the sub-study, participants continued their high blood pressure treatments. About four years later, researchers followed up with participants and divided them into two groups based on intensity of their condition: Participants with a systolic blood pressure of 120 received a standard treatment; those with a  systolic blood pressure of 140 received intensive treatment. 

Participants of each group went through another round of brain MRIs. Scans of older participants showed higher volumes of: 

• Perivascular space, which are fluid-filled spaces surrounding certain blood vessels in the brain.
• Atrophy, which is the loss of nerve cells and the connections that help them communicate in the brain's tissues. It’s associated with stroke, Alzheimer's, disease, traumatic brain injury, multiple sclerosis, infections, aging and declining brain health. 
• White matter hyperintensities, which suggest damage to the smaller vessels in the brain. 

But after factoring in age and gender, comparison scans found that at the beginning of the study, both groups had similar perivascular space volume. At the end of the study, scans found participants in the intensive treatment group had significantly decreased perivascular space volume when compared to the standard treatment group participants. 

Researchers believe that toxins and byproducts accumulate in the perivascular spaces of your brain, contributing to the development of dementia. Your heartbeat drives pulsations in your cerebral arteries that help clear these toxins and byproducts. However, over time blood pressure can cause arteries to stiffen, interfering with the ability of the arteries to remove toxins and byproducts. 

But intensive blood pressure control appears to open a pathway in the brain to help rid toxins and byproducts from the perivascular spaces, reducing brain damage. Furthermore, intensive blood pressure control also may slow the accumulation of hyperintensities. More research is needed; in fact, researchers have already identified their next step as finding how perivascular spaces relate to cognition and cognitive decline.

“The best advice I can give patients at this time is to work closely with your primary care doctor to prevent and control high blood pressure,” says Kaminetsky. “Follow a heart-healthy lifestyle, take medications as directed and monitor your blood pressure regularly.”

Looking for a primary care physician? Physicians in MDVIP-affiliated practices can customize a wellness plan for you that includes preventing and controlling high blood pressure. Find an MDVIP affiliate near you and begin your partnership in health »