Hypertension and Cognitive Decline in Older Adults: A Comprehensive Review

Hypertension is the leading risk factor contributing to the global burden of all-cause morbidity and mortality. Account for 9.4 million deaths per year and result in 212 million disability-adjusted life years lost in the affected population. Additionally, the prevalence of hypertension in individuals older than 60 years is approximately 60%, and this figure is expected to increase due to population ageing. Clearly, there exists a harmful association between hypertension and cognitive function. Mild Cognitive Impairment (MCI) refers to the alteration of cognitive functions without significantly impairing instrumental activities of daily living. Its clinical significance lies in its role as the initial manifestation of Alzheimer’s disease. Persistent exposure to elevated blood pressure triggers microcirculatory damage, promoting cerebral atrophy and blood-brain barrier dysfunction. It is estimated that older adults with hypertension have up to a 40% increased relative risk of MCI and a 70% increased relative risk of dementia. Clinically, older adults with MCI may present with an insidious onset of memory loss and impairment of executive function, also referred to as abstract reasoning, involving frontal and subcortical brain structures. These deficits manifest as difficulties in task planning, time management, self-care activities, and decreased cognitive processing speed. These observations underscore the importance of intensive and sustained blood pressure control, as hypertension is the most extensively studied modifiable factor for slowing the progression of cognitive decline.