- Older adults who took medications to manage their high blood pressure had a lower risk of dementia compared to those with untreated hypertension.
- Experts recommend treating high blood pressure in older adults as long as possible, while monitoring side effects
- People concerned about medication side effects should talk to their health care provider about other options.
Treating high blood pressure in older adults reduces their risk of dementia, an analysis of previous research shows, providing more evidence that heart health and brain health are intimately connected.
In a new meta-analysis, published Sept. 12 in JAMA Network Open, researchers found that older adults with untreated high blood pressure were 42% more likely to develop dementia during the study period compared to healthy older adults. This was true even among 70- and 80-year-olds.
“We are learning so much more about dementia and how your vascular system impacts diseases within the brain as well as the heart,” said Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.
Weinberg was not involved in the newly published analysis.
The analysis found older adults with untreated high blood pressure also had a 26% greater risk of dementia than people with treated high blood pressure.
When researchers compared people with treated high blood pressure to healthy older adults, they found no statistical difference in dementia risk between the two groups.
The results were not affected by sex or race, researchers found.
“The study suggests that successful treatment of hypertension [high blood pressure] might bring down the risk of developing dementia to the level of individuals with no hypertension,” said Dr. S. Ahmad Sajjadi, a neurologist with UCI Health and associate professor of neurology at UCI School of Medicine in Orange, California, who was not involved in the new analysis.
Controlled blood pressure is key
In the study, researchers examined data from 17 previous studies that included a total of over 34,000 community-dwelling adults aged 60 to 110 in the U.S. and 14 other countries.
The average age of participants was 72 years and almost 60% were female. People were followed in the studies on average around 4 years.
The authors of the new study grouped older adults into three categories based on their status at the start of each study: healthy adults without high blood pressure or a history of blood pressure medication use; people whose high blood pressure was treated with medication; and people with untreated high blood pressure.
While the studies in the analysis included a wide range of people from different countries, one limitation is that researchers did not have information on which medications people were taking to treat their high blood pressure.
Dr. Guy L. Mintz, Director of Cardiovascular Health & Lipidology at Northwell Health’s Sandra Atlas Bass Heart Hospital at North Shore University Hospital in Manhasset, New York, pointed out that how high blood pressure is treated will vary among people. For example, someone with diabetes may be treated differently than someone who is retaining fluid.
Researchers also didn’t have data on whether people were successfully managing their high blood pressure with medication, which Mintz said matters.
“It’s one thing for a doctor to say to a patient, ‘You have hypertension, so I’m going to put you on a medication,’”Mintz, who was not involved in the analysis, told Healthline. “But you want to make sure they get to a target number, where their blood pressure is controlled.”
Benefits of treating older adults
In addition, an analysis of several clinical trials, published in the European Heart Journal, found that use of blood-pressure-lowering medications in late middle age and later in life lowered the risk of dementia.
So it seems natural that physicians would treat high blood pressure in patients, regardless of their age.
But Dr. Joseph A. Diamond, Director of Nuclear Cardiology at Long Island Jewish Medical Center in New Hyde Park, New York, said physicians may hesitate to treat older adults aggressively because of their higher risk of medication side effects.
In addition, “it is often perceived that it is too late [for them] to benefit from blood pressure reduction at an older age,” he told Healthline.
Despite those perceptions, the benefits of lowering high blood pressure — which include a reduced risk of heart attack and stroke, and a slowing of mental decline — outweigh the risk of mostly mild and reversible medication side effects, he said.
Controlling modifiable risk factors
Weinberg pointed out that while doctors should closely monitor drug side effects in older patients, “trying to keep people on antihypertensive therapy as long as reasonably possible is really important.”
“The ends really do justify the means, in terms of quality of life,” she told Healthline.
She recommends that, whenever possible, people concerned about possible side effects talk to their healthcare professional rather than stopping a medication on their own.
“It is so important to keep these people coming into the office and continuing the dialogue with their practitioners,” she said.
While the new study included people 60 years or older, Sajjadi said the results highlight the importance of controlling modifiable risk factors earlier in life, including high blood pressure, sedentary lifestyle, and diabetes and other chronic diseases.
“Even though conditions such as dementia are typically associated with later life,” he told Healthline, “we now know that many diseases leading to dementia start in our brains years before manifesting their symptoms.”
In addition, because there’s currently no cure for Alzheimer’s disease, Mintz said it becomes even more important to manage risk factors and improve your lifestyle, both of which can lower the risk of developing dementia.
Researchers found that older adults who treated their high blood pressure with medication had a lower risk of dementia compared to those with untreated hypertension.
Some doctors may avoid aggressively treating older patients with high blood pressure, but the new study suggests that there is still benefit, especially for brain health.
Doctors should monitor drug side effects in older patients, say experts, and work with them to continue controlling their high blood pressure.