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Hypertensive dementia and blood pressure management from JSH2025

Hypertension Research volume 48, pages 3326–3328 (2025)Cite this article

As the global population ages at an unprecedented rate, there is growing concern about a significant increase in the number of patients with dementia. Although disease-modifying drugs have been introduced, fundamental treatment remains challenging, and the importance of prevention continues to grow. Neuronal cells receive nutrients and oxygen from blood vessels, and the supply of these substances is closely related to blood flow. Therefore, long-term reduction in the blood supply to the brain due to vascular disorders that prevent adequate blood flow adapted to neural function can lead to a gradual decline in brain function and cognitive impairment [2]. Therefore, increased vascular burden from hypertension leads to reduced brain volume and an increased risk of cognitive impairment, suggesting that hypertension is a risk factor not only for vascular dementia but also for Alzheimer’s disease [3, 4]. For details on this fundamental mechanism, please refer to the JSH Statement recently summarized by the working group of the Japanese Society of Hypertension on “Prevention of Cognitive Impairment by Hypertension Management (PCIHM)” [5].

Based on the results of epidemiological studies targeting individuals with hypertension in middle age or those who maintained appropriate blood pressure through antihypertensive treatment, it is now consensus that hypertension in middle age is a risk factor for cognitive impairment in older age [6, 7]. Due to the necessity for long-term observation periods to determine whether antihypertensive therapy prevents dementia, intervention studies are difficult to conduct, and the effect of antihypertensive treatment on inhibiting cognitive decline has not been concluded. However, efforts to maintain appropriate blood pressure levels over the long term and reduce vascular load are necessary from the perspective of preventing dementia onset. On the other hand, there is no distinct evidence regarding the association between hypertension in older adults, antihypertensive treatment, and the onset of dementia. There are concerns that blood pressure variability or excessive blood pressure reduction due to antihypertensive treatment may increase the risk of dementia [8, 9]. However, appropriate antihypertensive treatment is recommended for the prevention of cerebrovascular disorders, reduction of vascular load, and prevention of decreased cerebral blood flow.

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  1. Department of Pharmacology, Ehime University, Graduate School of Medicine, Shitsukawa, Tohon, Ehime, 791-0295, Japan

    Masaki Mogi

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Mogi, M. Hypertensive dementia and blood pressure management from JSH2025. Hypertens Res 48, 3326–3328 (2025). https://doi.org/10.1038/s41440-025-02399-2

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