Blood Pressure Lowering May Decrease Cognitive Decline; But Are We Ready to Lower Blood Pressure in the Real World?

Dementia and hypertension are highly prevalent, epidemiologically related chronic conditions disproportionately affecting older persons; approximately 97% of persons with dementia [1] and 66% with hypertension are over the age of 65 [2]. With increasing life expectancy, the prevalence of both dementia and hypertension is projected to increase further. Both conditions increase morbidity and mortality, and are among the largest contributors to healthcare expenditure – the total estimated expenditure on dementia in the United States in 2020 was $ 305 billion [3], and the annual expenditure on hypertension is estimated to be around $ 131 billion [4]. In addition, hypertension is an independent modifiable risk factor for dementia [5,6]. More recently, we analyzed data from randomized controlled trials (RCTs) to show that lowering blood pressure (BP) may slow decline in cognition [7]. Unfortunately, BP control has declined in the recent years, from 54% in 2013 to 44% in 2017 [8]. Here we will discuss some current logistical issues with hypertension management in older patients and future directions.