Patients diagnosed with hypertension in middle age and at older ages experience faster cognitive decline, with uncontrolled hypertension predictive of more rapid declines in memory and global cognitive function, according to study results published in Hypertension.

Current data is inconclusive regarding the relationship between hypertension and cognitive function. Study researchers sought to determine whether hypertension and prehypertension could predict greater decline in cognitive performance in participants in the ELSA-Brasil study at 4-year follow up.

The multicenter ELSA-Brasil study included 15,105 civil servants in Brazil between the ages of 35 and 74 years. This study included 7063 participants of at least 55 years of age who had undergone cognitive function tests at a second study visit.

The study researchers assessed cognitive performance measured at both visits using standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The memory test score represented the sum of the number of correct words in learning, recall, and word recognition evaluations. The verbal fluency test assessed executive function, semantics, language, and explicit memory. The trail B tests examined concentration, attention, psycho-motor speed, mental flexibility, and visuomotor scanning. Study researchers also assessed participants’ blood pressure (BP) at each visit.

Participants in the study went an average of 3.8 years between each visit. At the first visit, the mean age of the population was 58.9 years. Over time, there was a statistically significant interaction between advancing age and hypertension with increased decline in memory (β=-0.0153; 95% CI, -0.0222 to -0.0083; P <.001), verbal fluency (β=-0.0065; 95% CI, -0.0129 to -0.0001; P <.05), and global cognitive score (β=-0.0072; 95% CI, -0.0115 to -0.0028; P <.01) between visits.

In addition, prehypertension represented an independent predictor of greater decline in the verbal fluency test (β=-0.0095; 95% CI, -0.0172 to -0.0018; P <.01) and global cognitive score (β=-0.0049; 95% CI, -0.0102 to -0.0003; P <.05) compared with normal BP.

Middle-age hypertension correlated with a sharper decline in memory test compared with participants without hypertension (β=-0.0072; 95% Cl, -0.0141 to -0.0003; P <.05). Later hypertension was also associated with a sharper decline in memory test (β=-0.0151; 95 Cl, -0.0237 to -0.0064; P <.001) and global cognitive score (β=-0.0080; 95% Cl, -0.0134 to -0.0025 P <.01).

Finally, uncontrolled BP was associated with a more rapid decline in the memory test (β=-0.0126; 95% Cl, -0.0222 to -0.0030; P <.01) and global cognitive score (β=-0.0074; 95% Cl, -0.0134 to -0.0013; P <.01) compared with controlled hypertension.

Limitations of this study included the reliance on self-reported ages at diagnosis, the young patient population, and as its relatively short follow-up duration.

The study researchers concluded that their findings corroborate “previous findings that both hypertension and prehypertension are associated with worse longitudinal trajectories in overall cognitive performance and different cognitive abilities after about 4-year follow-up” and “suggest that control of BP levels may be critical to preserving cognitive function at all ages.”


Menezes ST, Giatti L, Brant LCC, et al. Hypertension, prehypertension, and hypertension control: Association with decline in cognitive performance in the ELSA-Brasil cohort. Published online December 14, 2020. Hypertension. doi:10.1161/HYPERTENSIONAHA.120.16080

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