Treating Hypertension to Prevent Cognitive Decline and Dementia: Re-Opening the Debate

  • M. Florencia Iulita
  • Hélène GirouardEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 956)


Hypertension and dementia are two of the most prevalent and damaging diseases associated with aging. Chronic hypertension, particularly during mid-life, is a strong risk factor for late-life cognitive decline and impairment. Hypertension is also the number one risk factor for stroke and a major contributor to the pathogenesis of vascular dementia and Alzheimer’s disease. Despite the vast epidemiologic and mechanistic evidence linking hypertension to cognitive impairment, and the positive effects of blood pressure lowering on reducing the risk of post-stroke dementia, uncertainty remains about the benefit of antihypertensive medication on other forms of dementia. This chapter reviews the link between hypertension and cognition, and discusses the evidence for and against the use of antihypertensive medication for dementia prevention.


Hypertension Cognitive dysfunction Dementia Stroke Antihypertensive drugs Vascular risk factors 



ambulatory blood pressure monitoring


angiotensin-converting enzyme inhibitor


Alzheimer’s disease


angiotensin II


angiotensin-II receptor blocker


Anglo-Scandinavian Cardiac Outcomes Trial



blood-brain barrier


blood pressure


calcium channel blocker


confidence interval


diastolic blood pressure




Diagnostic and Statistical Manual of Mental Disorders, 4th Edition


Fludeoxyglucose (18F)-Positron Emission Tomography


Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability




Heart Outcomes Prevention Evaluation


hazard ratio


Hypertension in the Very Elderly Trial


International Classification of Diseases 10th Revision


Eighth Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure


mild cognitive impairment


mini mental state examination


Medical Research Council


magnetic resonance imaging


Pittsburgh compound B-Positron Emission Tomography


pulse pressure


Perindopril Protection Against Recurrent Stroke Study


relative risk reduction


systolic blood pressure


Study on Cognition and Prognosis in the Elderly


Systolic Hypertension in the Elderly


Systolic Blood Pressure Intervention Trial


Systolic Hypertension in Europe


vascular dementia



MFI would like to acknowledge support from the Herbert H. Jasper Postdoctoral Research Fellowship in Neurosciences from the Groupe de Recherche sur le Système Nerveux Central (GRSNC), Université de Montréal, and from a Bourse Postdoctorale from the Fonds de recherche du Québec – Santé (FRQS). HG would like to acknowledge support from the Heart and Stroke Foundation of Canada, the Canadian Institutes of Health Research and the Canadian Foundation for Innovation. HG is the holder of an investigator award from the FRQS.


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© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Neurosciences, Faculty of MedicineUniversité de MontréalMontréalCanada
  2. 2.Department of Pharmacology, Faculty of MedicineUniversité de MontréalMontréalCanada

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