15 July 2014

High blood pressure may protect elderly against dementia

In the extreme elderly those with the highest blood pressure were the least likely to have dementia, according to new research.


New research suggests high blood pressure may not be all bad. Elevated levels might help to stave off mental decline among the extreme elderly, the study suggests.

The finding follows a decade spent tracking high blood pressure and dementia among 625 men and women aged 90 and up.

Those with the highest blood pressure levels were the least likely to have dementia, the researchers found. But that doesn't mean older people shouldn't try to control elevated blood pressure, they said.

Read: Hypertension in the elderly

High blood pressure must still be treated

"On the basis of this work we are absolutely not recommending that high blood pressure not be treated among the elderly," said study co-author Maria Corrada, an associate adjunct professor in the department of neurology at the University of California, Irvine.

"What we are saying is that from observing a group of very old people we now have some evidence that developing high blood pressure at a late age may be helpful in terms of maintaining intact thinking abilities," she said.

The reason behind this association isn't clear, Corrada said. "It could be that high blood pressure improves the blood flow to their brain... But we don't know. It will certainly require more study to better understand the mechanism behind this."

The study didn't prove that high blood pressure leads to improved mental acuity among the very old, it just found a link between the two.

Read: Improved treatment for high blood pressure

Corrada and her colleagues are scheduled to discuss their findings this week in Copenhagen, Denmark at an international meeting of the Alzheimer's Association. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal.

Battery of tests

For the study, the study authors focused on men and women aged 90 to 103 – the "oldest old."

Almost seven in 10 participants were women, and at the start of the study none had dementia. All underwent an initial battery of mental health and neurological testing, as well as blood pressure assessments.

Then, for up to 10 years, all participants were re-evaluated every six months.

Overall, 259 were diagnosed with dementia. And nearly three-quarters took some form of medication to control high blood pressure, which is linked to heart disease and stroke.

Read: A healthy heart may keep your mind sharp

Even lower dementia risk

The research team found that those who had developed high blood pressure during their 80s faced a lower risk of developing dementia than those with normal blood pressure. And participants first diagnosed with high blood pressure during their 90s had an even lower dementia risk.

Even those whose blood pressure was slightly elevated – called "pre-hypertension" – had a lower risk for dementia than those with normal blood pressure, the study found.

The absolute lowest dementia risk was seen among those whose high blood pressure was the most advanced. The association held whether or not people took medication for their high blood pressure.

Read: Seniors need less blood pressure medication


This led the research team to conclude that high blood pressure seems to be associated with a lower risk for dementia among the extreme elderly. Moreover, the worse a person's blood pressure status is, the better their thinking capacities, the researchers said.

"Now it should be said that people who survive to age 90 and above are, by definition, very different than people who survive to their 70s or 80s," said Corrada. "Obviously, they didn't have stroke or heart disease that took their lives. Or maybe they didn't have it at all. And more specifically, these may be people who have developed high blood pressure now, but did not struggle with it throughout their life."

Catherine Roe, an assistant professor of neurology at Washington University School of Medicine in St. Louis, said the findings seem to "fit with what we know about high blood pressure".

Read: Brain structure influences thinking

"High blood pressure during middle-age is a risk factor for later development of dementia," Roe said. "That's pretty clear from past research. But the study results have been mixed on whether high blood pressure for people in their 60s and 70s is related to cognition problems or not." Cognition refers to thinking and memory.

It appears that high blood pressure becomes less of a risk factor for mental decline in old age, Roe added. However, "high blood pressure is probably still bad for a lot of other reasons," she said.

Perhaps people who live to very advanced ages have a kind of "super health" that helps them withstand the impact of high blood pressure, she suggested.

Read more:

Study links traumatic brain injury to increased dementia risk
When is blood pressure considered high?

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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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