More aggressive treatment of high blood pressure may be necessary for those hoping to lower their risk of both mild cognitive decline and dementia, according to new expert recommendations.
The American Heart Association and the American College of Cardiology recently issued new guidelines intended to help health care providers both prevent and manage high blood pressure.
This is the first time since 2017 that the guidelines have been updated.
What is high blood pressure?
High blood pressure is when the pressure in the body’s arteries stays elevated over a long period. It typically does not cause symptoms but instead quietly and seriously damages a person’s health over time.
Nearly half of all adults in the United States have high blood pressure, which is a reading higher than 130/80 mm Hg. The American Heart Association says the condition is the No. 1 preventable risk factor for several diseases, including:
- Cardiovascular disease, including heart attack, stroke and heart failure
- Kidney disease
- Cognitive decline and dementia
Despite the new guidelines, the AHA’s definitions of both normal and high blood pressure have not changed. They are:
- Normal blood pressure: Less than 120/80
- Elevated blood pressure: 120-129 systolic and more than 80 diastolic
- Stage 1 hypertension: 130-139 systolic or 80-89 diastolic
- Stage 2 hypertension: 140+ systolic or 90+ diastolic
Systolic blood pressure is the first number in a reading, such as the “120” in “120/80.” Diastolic blood pressure is the second number, such as the “80” in that example.
About the updated guidelines
Under the new guidelines, health care providers are urged to use the AHA’s PREVENT risk calculator to estimate a person’s risk of cardiovascular disease.
The calculator estimates a person’s risk of developing heart disease in the next 10 years and in the next 30 years. It is intended for patients aged 30 to 79 who don’t currently have heart disease.
The guidelines also advise health care providers to consider prescribing medications that mimic the hormone GLP-1 — such as Ozempic and Wegovy — to patients who are both hypertensive and overweight or obese.
The AHA and American College of Cardiology also recommend that providers offer more detailed recommendations for managing blood pressure before, during and after pregnancy. Doing so can reduce the risk of both short-term and long-term health complications, including preeclampsia.
Finally, the new guidelines reaffirm the importance of healthy lifestyle behaviors — such as those on the AHA’s Life’s Essential 8 list — in preventing and managing blood pressure. They include improving diet, quitting tobacco, and managing blood sugar and cholesterol.
High blood pressure and dementia risk
One of the most notable things about the new guidelines is how they differ from the 2017 guidelines in regard to dementia.
The 2017 guidelines simply stated that “BP lowering is reasonable to prevent cognitive decline and dementia.”
The updated guidelines recommend that people keep their systolic blood pressure under a specific number — 130 — to prevent cognitive decline and dementia. (Again, systolic blood pressure is the first number in a reading, such as the “120” in “120/80.”)
Recent research has found that high blood pressure damages small blood vessels in the brain, which can result in memory problems and cognitive decline. Thus, early treatment of high blood pressure is likely to reduce the risk of cognitive decline and dementia.
The AHA notes that some of the best ways to lower blood pressure include:
- Eating a heart-healthy diet, including lowering salt intake
- Remaining physically active
- Maintaining a healthy weight
- Lowering stress
- Taking blood pressure medication if necessary
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