A Comprehensive Systematic Review of The Relationship between Uncontrolled Hypertension and the Incidence of Vascular Dementia

Introduction: Hypertension is a highly prevalent modifiable risk factor for dementia, yet the specific relationship between uncontrolled hypertension and vascular dementia remains incompletely characterized. This systematic review aims to synthesize current evidence on the association between uncontrolled hypertension and vascular dementia incidence, examining the effects of blood pressure control, treatment duration, and age-dependent factors. Methods: A systematic literature search was conducted following PRISMA guidelines. Studies were included if they examined adult patients (≥18 years) with diagnosed hypertension, clearly defined uncontrolled hypertension as an exposure variable, assessed vascular dementia as a primary or secondary outcome, and provided analyzable data. Observational studies (cohort, case-control, cross-sectional), systematic reviews, and meta-analyses were eligible. Data extraction encompassed study characteristics, hypertension definitions, dementia outcomes, association findings, confounders, and quality indicators. Results: One hundred twenty-five studies met inclusion criteria, encompassing over 2.6 million participants across diverse geographic settings. Uncontrolled hypertension was consistently associated with increased vascular dementia risk, with incidence rates of 8.1 versus 4.9 per 1,000 person-years in uncontrolled versus controlled groups (p