Uncontrolled hypertension can result in cognitive deficits over time

Patients diagnosed with hypertension in middle and older ages experience more rapid cognitive decline, with uncontrolled hypertension predicting faster decline in memory and global cognitive function, according to study results published in Hypertension.

Current data are inconclusive about the relationship between high blood pressure and cognitive function. The study’s researchers wanted to find out whether hypertension and pre-hypertension could predict a greater decline in cognitive performance in the participants in the ELSA-Brasil study after 4 years.

The multicenter ELSA-Brasil study included 15,105 civil servants in Brazil between the ages of 35 and 74 years. This study included 7063 participants aged 55 or over who had undergone cognitive function tests on a second study visit.

The study researchers rated cognitive performance measured on both visits using standardized assessments of memory, verbal language proficiency, Trail B tests, and global cognitive score. The memory test score was the sum of the number of correct words in learning, recall, and word recognition scores. The verbal fluidity test assessed executive function, semantics, language, and explicit memory. The Trail B tests examined concentration, alertness, psychomotor speed, mental flexibility, and visuomotor scanning. The study researchers also rated the participants’ blood pressure (BP) at each visit.

Study participants spent an average of 3.8 years between each visit. At the first visit, the mean age of the population was 58.9 years. Over time, there was a statistically significant interaction between advancing age and hypertension with an increased decrease in memory (β = -0.0153; 95% CI, -0.0222 to -0.0083; P <0.001) and the verbal one Language proficiency (β = -0.0065; 95)% CI, -0.0129 to -0.0001; P <0.05) and global cognitive score (β = -0.0072; 95% CI, -0.0115 to -0.0028; P <0.01) between visits.

In addition, pre-hypertension provided an independent predictor of a greater decrease in the verbal fluence test (β = -0.0095; 95% CI, -0.0172 to -0.0018; P <0.01) and in the global cognitive score (β = -0.0049; 95% CI) is -0.0102 to -0.0003; P <0.05) compared to normal blood pressure.

Middle-aged hypertension correlated with a greater decrease in the memory test compared to participants without hypertension (β = -0.0072; 95% Cl, -0.0141 to -0.0003; P <0.05). Later hypertension was also associated with a greater decline in the memory test (β = -0.0151; 95 Cl, -0.0237 to -0.0064; P <0.001) and the global cognitive score (β = -0.0080; 95 % Cl, -0.0134 to -) linked 0.0025 P <0.01).

Finally, there was uncontrolled blood pressure with a faster decline in the memory test (β = -0.0126; 95% Cl, -0.0222 to -0.0030; P <0.01) and the global cognitive score (β = -0, 0074; 95% Cl; -0.0134 to -0.0013; P <0.01) compared to controlled hypertension.

The limitations of this study included the dependence on self-reported age at diagnosis, the young patient population, and the relatively short follow-up period.

The study’s researchers concluded that their results “confirm previous results that both hypertension and prehypertension are associated with poorer longitudinal trajectories of overall cognitive performance and different cognitive abilities after approximately 4 years of follow-up” and “suggest that the Controlling blood pressure levels could be critical to maintaining cognitive function at any age. ”


Menezes ST, Giatti L., Brant LCC et al. Hypertension, prehypertension, and hypertension control: association with a decline in cognitive performance in the ELSA-Brasil cohort. Published online December 14, 2020. Hypertension. doi: 10.1161 / HYPERTENSIONAHA.120.16080

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