Hypertension, cognitive decline, and dementia: an epidemiological perspective

Hypertension is a known risk factor for stroke, and thus for vascular dementia. However, recent large observational studies have suggested that high blood pressure may also play a role in Alzheimer's disease. The mechanisms linking hypertension to Alzheimer's disease remain to be elucidated, but white matter lesions seen on cerebral magnetic resonance imaging appear to be a good marker of this association. It is not yet clearly established whether lowering blood pressure reduces the risk of white matter lesions and dementia, so large trials dealing with this question are eagerly awaited. These future trials could confirm the hope that, by lowering blood pressure, we may have a preventive treatment for dementia. This issue is of major importance, as the number of cases of dementia is expected to rise sharply in the near future.