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    Hypertension, Target Organ Injury, and the Brain

    Do elevated blood pressures lead to cognitive dysfunction?


    Answer: All 3 statements are true.2

    Although clinical data are preliminary, evidence is accumulating for an association between small vessel pathology/dementia and hypertension and also for a protective effect for select drugs to treat hypertension, ie, thiazide diuretics.2

    The benefits of antihypertensive therapy to help prevent cognitive decline is a work in progress. It appears based on the current evidence that lowering blood pressure may decrease the incidence of new-onset dementia. In addition, preliminary data suggest that agents such as thiazide diuretics may slow the progressive debility of dementia. 

    The brain pathology that results from stroke is a result of large vessel injury. The presumed smaller size of the vessel injured in dementia will make research more complex, but the early returns suggest that hypertension is a “player.”  That is a solid foundation to build on!



    1. Tzourio C, Dufouil C, Ducimetiere P, et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology 1999;53: 1948-52.

    2. Guo Z, Fratiglioni L, Zhu L, et al. Occurrence and progression of dementia in a community population aged 75 years and older: relationship of antihypertensive medication use. Arch. Neurol. 1999; 56:991-996.

    3. Csiszar A, Tarantini S, Fulop GA, et al. Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer’s Disease. Geroscience 2017; Aug. 29 doi: 10.1007/s11357-017-9991-9, Epub ahead of print.

    4. Sparks DL,  Scheff W, Liu H, et al. Increased incidence of neurofibrillary tangles in non-demented individuals with hypertension. J Neurol. Sci. 1995;131:162-169.



    Gregory W. Rutecki, MD
    Dr Rutecki is with the Cleveland Clinic National Consultation Service.

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      What is it about HCTZ that other antihypertensives lack that helps to decrease dementia?