“What’s good for the heart is good for the head” also happens to be a simple but smart prescription for avoiding dementia.
Hypertension or high blood pressure affects nearly half of U.S. adults and is a leading modifiable risk factor for cognitive decline in later years—a big reason why taking care of your heart will lead to better overall brain health, especially when one enters their 80s.
Evidence from a recent U.K. study reported antihypertensive medication classes reduce mild cognitive impairment (MCI) and dementia risk even at older ages compared with standard blood pressure treatments. And with no effective treatments for dementia currently available, prevention through targeted hypertension control is even more important.
…with no effective treatments for dementia currently available, prevention through targeted hypertension control is even more important.
Antihypertensive use is especially important for African Americans who are at much higher risk for hypertension and dementia. In fact, about 55% of black adults have high blood pressure and have disproportionately high rates of more severe cases.
Results of a recent dedicated study of older African Americans showed a similar positive impact of commonly available antihypertensive medications, which reduced risks of both cardiovascular events and dementia.
Know your numbers: New guidelines define hypertension stages
Evidence suggests that reduction of blood pressure by 5 mm Hg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%, and can reduce the likelihood of dementia, heart failure and mortality from cardiovascular disease.
In 2017, The American Cardiology College and American Heart Association established new guidelines for the detection, prevention, management and treatment of high blood pressure, and their recommendations indicate that high blood pressure should be treated early with lifestyle changes (and in some patients with medication) at 130/80 mm Hg rather than 140/90. The guidelines recognize the new numbers account for complications that can occur with untreated or undiagnosed high blood pressure and allow for earlier intervention.
Dr. Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines, said that establishing new numbers should be considered a “yellow light” and that people with hypertension need to lower blood pressure.
“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said. “We want to be straight with people: If you already have a doubling of risk, you need to know about it.”
Whelton concluded that higher numbers don’t necessarily indicate immediate medication intervention and that non-drug approaches like diet should first be implemented. Long-term study results reveal that physical activity continues to offer some protection against vascular dementia but not Alzheimer’s or all-cause dementia.
Blood pressure guidelines
Normal: Less than 120/80 mm Hg;
Elevated: Systolic between 120-129 and diastolic less than 80
Stage 1: Systolic between 130-139 or diastolic between 80-89
Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
Stage 3: Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
In addition, the guidelines stress the importance of using proper technique to measure blood pressure and recommend home blood pressure monitoring using validated devices.
Antihypertensives: Which medications are right for you?
Antihypertensives are a class of drugs used to treat hypertension, prevent the complications of high blood pressure (such as stroke and myocardial infarction) and reduce blood pressure in various ways. Some medications widen blood vessels so blood gets through more easily, and others remove extra fluids from blood or block natural hormones implicated in high blood pressure.
In addition to age, race and gender, health care providers will consider other medical problems and current blood pressure levels when deciding which medication(s) to prescribe.
Physicians may prescribe a combination of medications to bring blood pressure numbers down and recommend one antihypertensive agent and add a second or third. They may also start and stop antihypertensive drugs that aren’t achieving desired results or if patients develop intolerable side effects or if unsafe changes in blood work are present.
Experts recommend drugs from one of the four following classes as either initial therapy or as an add-on treatment:
Diuretics – Diuretics help the kidneys eliminate excess salt and water from the body’s tissues and blood. Experts recommend thiazide-type diuretics to be one of the first-line drug treatments for hypertension, either as monotherapy or in combination with calcium channel blockers, ACE inhibitors, or angiotensin II receptor antagonists.
Calcium channel blockers – Calcium channel blockers block the entry of calcium into muscle cells in artery walls and are often recommended as a first-line treatment, either as monotherapy or in combination with thiazide-type diuretics, ACE inhibitors or angiotensin II receptor antagonists for all patients regardless of age or race.
ACE inhibitors – ACE inhibitors inhibit the activity of angiotensin-converting enzyme (ACE), responsible for the conversion of angiotensin I into angiotensin II, a potent vasoconstrictor. ACE inhibitors are more effective at slowing down the decline of kidney function compared to calcium channel blockers and beta blockers and are often the drug of choice for patients with chronic kidney disease, regardless of race or diabetic status.
Angiotensin II receptor antagonists (ARBs) – ARBs are often as effective as ACE inhibitors and typically are better tolerated. Recent studies have shown they produce a greater decrease in cardiovascular events than ACE inhibitors, especially in patients with established cardiovascular disease.
Many studies point to the benefits of antihypertensive medications to reduce blood pressure and lessen correlated dementia risks, but the preferred initial course of treatment is lifestyle-based.