Dr Audrey Adji

Blood pressure and cognitive performances in middle-aged adults: the Aging, Health and Work longitudinal study.
Rouch L, Cestac P, Hanon O, Ruidavets JB, Ehlinger V, Gentil C, et al.
Journal of Hypertension 2019 37:1244-1253.

This paper reported that hypertensive individuals had poorer global cognitive performances over time compared with normotensives. When the study compared those with controlled hypertension (by antihypertensive therapy) and those untreated/ uncontrolled, the former had better cognitive performances than the latter. This longitudinal study confirmed the proposition by Stone et al (Journal of Alzheimers’ Disease 2015; 44:355-373) that “the brain is destroyed by the pulse”. Stiffening of the central elastic arteries associated with aging will cause a rise in pulsatile flow and pressure from the heart into the microvasculature of highly perfused organs, especially brain and kidneys, due to reduced ability of these arteries to cushion the higher pulsation. These high pulsations will predispose the microvasculature to arterial walls rupture and microhaemorrhages, resulting in microinfarcts which will lead to poorer cognitive function and dementia. Reduction of pulsatile central pressure by blood pressure control can prevent the damage and could delay ill-effects of the arterial stiffness. The French paper further emphasises the importance of blood pressure control by antihypertensive.