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Lower Blood Pressure Slashes Dementia Risk

February 2019

By Abby Gonzalez

A new study has confirmed that poor blood pressure control not only increases risk of heart attack and stroke but can also hasten the onset of dementia.

This finding made the following headline news articles:

Washington Post

“A healthier heart may mean a healthier mind, new study shows”

NBC News

“Tight blood pressure control can cut memory loss, study finds”

USA Today

“Aggressively lowering blood pressure could reduce risk of developing dementia, study finds”

High blood pressure is a well-known cardiac risk, but now researchers are discovering that elevated blood pressure damages the brain and can lead to dementia and mild cognitive decline.

Preliminary results of a subset of participants from a large clinical trial called SPRINT were presented at the Alzheimer’s Association International Conference in July 2018. The findings showed that keeping tight control of blood pressure can reduce the risk of developing mild cognitive impairment by 19%.1

Furthermore, maintaining a new lower systolic blood pressure target of less than 120 mmHg can reduce risk of mild cognitive impairment plus probable dementia from any cause by 15%.

These findings should come as no surprise to readers of Life Extension Magazine®.

Life Extension has long advocated for a systolic target of less than 120 mmHg.2

Systolic blood pressure is the upper reading and is the most important to keep under control as it represents the force of pressure the arteries endure with each heartbeat.

Given the connections between cardiovascular disease and mild cognitive impairment and dementia, the new findings make the topic of blood pressure control even more compelling.3-6

This data makes it even more imperative that readers attempt to achieve optimal blood pressure control for the sake of their heart and their brain.

Blood Pressure Recommendations

For most aging individuals, Life Extension recommends an optimal blood pressure goal of 115/75 mmHg. However, those aging individuals with long-standing hypertension and/or coronary artery disease, individuals with kidney disease, and those over 80 years of age should be aware that a rapid, overly aggressive reduction of blood pressure should be avoided. Signs of overly aggressive blood pressure reduction may include worsening cognitive function, dizziness and/or lightheadedness when standing quickly from a sitting position, and worsening biomarkers of kidney function.

Regrettably, some older, fragile patients may simply not tolerate a target blood pressure of 115/75 mmHg due to long-standing damage to the vascular system, thus requiring a higher perfusion pressure to meet physiologic demands. In these fragile patients, maintaining the lowest blood pressure tolerated is reasonable.

Life Extension recommends frequent blood testing of kidney function biomarkers like BUN and creatinine when embarking on an aggressive blood pressure control program. Also, Life Extension strongly recommends that all people purchase a low-cost at-home blood pressure monitor so they can check themselves when trying new medications or nutrients.

Mainstream Medicine Wakes Up to Blood Pressure Risks

In 2015, a group of researchers published their findings on 9,361 older adults with systolic (top number) blood pressure of 130 mmHg or higher, and who also had increased cardiovascular risk factors (but not diabetes).7

The name of this trial was SPRINT and it randomly assigned subjects to two protocols. The first was an intensive strategy aiming for a systolic goal of less than 120 mmHg, versus the routine standard of care aiming for the then-standard goal of less than 140 mmHg.7

Results from the SPRINT trial were so dramatic that the study was stopped early by a safety monitoring committee, which found it would be unethical to continue the random assignment because of the clear-cut benefits arising from adopting the goal of lower blood pressure (less than 120 mmHg).8

Those benefits included a 25% reduction in risk of first heart attack or other coronary artery problems, stroke, heart failure, or death from cardiovascular causes, and a significant 27% reduction in risk of dying from any cause.8

Publication of SPRINT’s findings led to a revision of the American Heart Association’s guidelines for managing hypertension. Mainstream medicine was finally endorsing the blood pressure standards that Life Extension® had advocated for decades.2,9,10

Impact of Blood Pressure on Cognition

A person holding a test tube

The outcome measures in the original SPRINT trial purely focused on cardiovascular findings.

These are important but fail to capture the full scale of the destruction wrought by continuous pounding of vessels in hypertensive people, which have been known to increase the risk of dementia (e.g., Alzheimer’s) and its precursor, mild cognitive impairment.11,12

Mild cognitive impairment increases the risk of progressing to Alzheimer’s or other dementias, making it a finding that should concern anyone. 13

For these reasons, researchers chose a subgroup of subjects from the SPRINT study to explore whether achieving the lower blood pressure target could also reduce the risk of mild cognitive impairment and/or dementia.

That subgroup study was called SPRINT MIND. It produced results as enlightening as the original SPRINT trial.

New cases of mild cognitive impairment were reduced by 19% in the group with lower blood pressure.1 And the combined outcome of mild cognitive impairment plus probable dementia from all causes was reduced by 15% compared with those undergoing standard blood pressure management.

This is a tremendous validation of Life Extension’s call for lower blood pressure targets and shows that stringent control can protect not only the heart but also the brain.

SPRINT MIND found other brain benefits for lower blood pressure.

Lower Blood Pressure Slows Brain Lesions

Heartrate chart

The brains of people afflicted with dementia have impairments in the blood vessels that supply brain tissue. On an MRI scan, these impairments are visible as white matter lesions (or white matter hyperintensities, sometimes called leukoaraiosis).1,4

Studies have shown that white matter lesions predict stroke, dementia (both vascular dementia and Alzheimer’s disease), and also increased risk of dying.1 Hypertension is the main risk factor for developing white matter lesions.14

A portion of the SPRINT MIND participants had MRI scans of their brains to determine whether achieving the targeted lower blood pressure levels could also reduce these dangerous indicators of dementia and stroke risk.1

What this part of the study showed was that in the standard treatment group (less than 140 mmHg), the total volume of white matter lesions increased by 0.92 cubic centimeters (cc), while in the intensive treatment group (less than 120 mmHg) that increase was held to just 0.28 cc. This means those in the intensive treatment (less than 120 mmHg) group had a beneficial 3.25 times lower volume of toxic white matter lesions.1

This research shows that the new, lower blood pressure target achieved by the intensive management group (under 120 mmHg) in SPRINT MIND resulted in lower rates of mild cognitive impairment as well neurodegenerative factors like white matter lesions that can lead to dementia and stroke.1

Importance of At-Home Blood-Pressure Monitoring

Everyone who has been diagnosed with high blood pressure should have an at-home monitor in order to ensure that any intervention they are undertaking is working to help keep their blood-pressure readings around 115/75 mmHg throughout the day.

Monitoring your blood pressure at home may help you better control it, possibly obviating the need to increase medication dosage.

In a randomized, controlled trial, 136 participants with uncontrolled high blood pressure were assigned to at-home blood-pressure monitoring or usual care. Their medication regimen was not modified.15

Those who regularly monitored their blood pressure at home saw significant reductions in systolic and diastolic blood pressure compared with those who did not self-monitor.

At the end of the two-month trial, 32.4% of the self-monitoring (at-home) group had blood pressure of less than 130/80 mmHg, while only half as many participants—16.2%—who did not self-monitor saw their blood pressure fall below this level.15

Several other studies have found similar benefits associated with at-home blood-pressure monitoring.16-19

Reliable blood pressure monitors are widely available in pharmacies without the need for a prescription.

You also have the option of ordering one from Life Extension by calling 1-800-544-4440 (24 hours). The price for an AccuFit™ Plus Cuff Multi-User Blood Pressure Monitor is only $49.99. Item #70000.

Summary

Hypertension has long been called the “silent killer.” Despite strong evidence, mainstream medicine has only recently adopted a blood pressure target (less than 120 mmHg systolic) similar to Life Extension’s long-standing target recommendation of 115/75 mmHg.

The change came after a giant study called SPRINT showed the cardiovascular risk reductions in those who target their blood pressure to the new lower standard.

More evidence now shows that most older adults should strive for an optimal target of less than 120 mmHg. People who were able to attain this level were nearly 20% less likely to develop mild cognitive impairment—which is a known risk factor for Alzheimer’s and other dementias.

Cardiovascular disease and dementia are rampant in older populations. By aggressively managing blood pressure you can help prevent both. A combination of weight loss, prescription medications, and supplements is likely to produce the best results in those with higher than optimal blood pressure readings.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

References

  1. Kjeldsen SE, Narkiewicz K, Burnier M, et al. Intensive blood pressure lowering prevents mild cognitive impairment and possible dementia and slows development of white matter lesions in brain: the SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study. Blood Press. 2018 Oct;27(5):247-8.
  2. Available at: https://www.lifeextension.com/Magazine/2018/3/Blood-Pressure-Control-Around-the-Clock/Page-01. Accessed 14 September, 2018.
  3. Geroldi C, Ferrucci L, Bandinelli S, et al. Mild cognitive deterioration with subcortical features: prevalence, clinical characteristics, and association with cardiovascular risk factors in community-dwelling older persons (The InCHIANTI Study). J Am Geriatr Soc. 2003 Aug;51(8):1064-71.
  4. Suwa M, Yamaguchi S, Komori T, et al. The Association between Cerebral White Matter Lesions and Plasma Omega-3 to Omega-6 Polyunsaturated Fatty Acids Ratio to Cognitive Impairment Development. Biomed Res Int. 2015;2015:153437.
  5. Vicario A, Cerezo GH, Del Sueldo M, et al. Neurocognitive disorder in hypertensive patients. Heart-Brain Study. Hipertens Riesgo Vasc. 2018 Oct - Dec;35(4):169-76.
  6. Yzeiraj E, Tam DM, Gorodeski EZ. Management of Cognitive Impairment in Heart Failure. Curr Treat Options Cardiovasc Med. 2016 Jan;18(1):4.
  7. Group SR, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):
    2103-16.
  8. Wright JT, Jr., Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22): 2103-16.
  9. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-e248.
  10. Available at: https://www.lifeextension.com/Magazine/2018/3/As-We-See-It/Page-01. Accessed,
  11. Reitz C, Tang MX, Manly J, et al. Hypertension and the risk of mild cognitive impairment. Arch Neurol. 2007 Dec;64(12):
    1734-40.
  12. Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996 Apr 27;347(9009):1141-5.
  13. Ciobica A, Padurariu M, Bild W, et al. Cardiovascular risk factors as potential markers for mild cognitive impairment and Alzheimer’s disease. Psychiatr Danub. 2011 Dec;23(4):340-6.
  14. Muscari A, Faccioli L, Ghinelli M, et al. Hypertension and Other Determinants of White Matter Lesions in Stroke Patients. J Clin Hypertens (Greenwich). 2016 Sep;18(9):907-12.
  15. Fuchs SC, Ferreira-da-Silva AL, Moreira LB, et al. Efficacy of isolated home blood pressure monitoring for blood pressure control: randomized controlled trial with ambulatory blood pressure monitoring - MONITOR study. J Hypertens. 2012 Jan;30(1):75-80.
  16. Agena F, Prado Edos S, Souza PS, et al. Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP. Nephrol Dial Transplant. 2011 Nov;26(11):3745-9.
  17. Breaux-Shropshire TL, Judd E, Vucovich LA, et al. Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes. Integr Blood Press Control. 2015;8:43-9.
  18. Fuchs SC, Mello RG, Fuchs FC. Home blood pressure monitoring is better predictor of cardiovascular disease and target organ damage than office blood pressure: a systematic review and meta-analysis. Curr Cardiol Rep. 2013 Nov;15(11):413.
  19. Imai Y, Obara T, Asamaya K, et al. The reason why home blood pressure measurements are preferred over clinic or ambulatory blood pressure in Japan. Hypertens Res. 2013 Aug;36(8):661-72.
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