Sex differences in the association between hypertension, cerebral small vessel disease and cognitive decline: a narrative review.

The objective of this study was to review how cerebral small vessel disease (CSVD) is associated with hypertension and cognitive decline, specifically regarding sex differences in this association. Strong evidence supports the associations between hypertension and cognitive decline, hypertension and CSVD, as well as CSVD and cognitive decline in both women and men. Sex-stratified analyses show that compared to men, hypertension leads to worse cognitive decline in women likely due to its stronger association with CSVD in women. Indeed, compared to men, prevalence of CSVD and CSVD lesion progression is also higher in women and later in life, the incidence of hypertension is higher in women. Moreover, the association between hypertension and CSVD was found to be stronger in women, as was the association between hypertension and cognitive decline. Therefore, focus on hypertension and CSVD as an important pathophysiological mechanism for cognitive decline may uncover novel sex-specific therapeutic avenues.