Measures of vascular health from routine blood pressure measurements may help identify adults at high risk for dementia, according to research presented at the American College of Cardiology’s Annual Scientific Sessions (ACC.26). The results of two studies that tracked patterns of arterial stiffness over time are consistent with growing evidence that uncontrolled high blood pressure accelerates the aging and stiffening of blood vessels and contributes to the development of dementia.
As the population ages, the rates of dementia and age-related cognitive decline are expected to increase. At the same time, almost half of adults in the United States have high blood pressure, but many people don’t know they have high blood pressure, making it known as the “silent killer.” Efforts to properly address high blood pressure, a leading cause of heart disease and a risk factor for dementia, can impact both heart and brain health. The 2025 ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults lists blood pressure as the most common and modifiable risk factor for the development of cardiovascular disease and dementia due to cerebrovascular damage.
Blood pressure management does more than just prevent heart attacks and strokes. It may also be one of the most viable strategies for maintaining cognitive health. To address high blood pressure in young adults before damage begins to accumulate, you need to start thinking about hypertension management much earlier than you would normally. ”
Newton Nyirenda, MD, epidemiologist at Georgetown University in Washington and lead author of the study
The two studies, by the same research team, focused on risk scores that identify patients who are more likely to develop dementia. One study showed that pulse pressure (heart rate index), calculated from heart rate and blood pressure measurements, independently predicted dementia risk in adults over 50. In another study, researchers found that adults with persistently elevated or rapidly increasing estimated pulse wave velocity (a marker of vascular aging calculated from age and blood pressure) were significantly more likely to develop dementia compared to adults with more stable vascular profiles.
“Our findings suggest that vascular aging patterns may provide meaningful insight into future dementia risk,” Dr. Nyirenda said. “This supports the idea that managing vascular health early in life can impact long-term brain health.”
The study analyzed 8,536 participants from the SPRINT trial, a large multicenter study of adults aged 50 and older with hypertension. As a result of follow-up, 323 participants developed suspected dementia. The researchers examined pulse pressure heart rate indices and estimated pulse wave velocity patterns over a 5-year period.
The results showed that participants under the age of 65 with high pulse pressure and heart rate indices had a significantly higher risk of developing possible dementia and mild cognitive impairment, with each unit increase in pulse pressure and heart rate index increasing the risk by 76%. Participants with higher estimated pulse wave velocity profiles had an increased risk of developing dementia, even after accounting for clinical risk factors such as age, gender, kidney disease, cardiovascular history, and smoking.
Because the components of pulse pressure heart rate index and estimated pulse wave velocity are routinely measured during primary care visits, the researchers said that risk scoring based on either of these metrics should be relatively easy to integrate into clinical workflows. By discussing the risk of dementia in this light, Nyirenda said, more patients may be able to reduce their risk by making lifestyle changes and taking medications as needed to lower their blood pressure.
“Clinicians should focus on individualizing risk assessments and tailoring treatment strategies to help improve patients’ cardiovascular health while preventing neurocognitive decline,” said lead author Sula Majimba, M.D., associate professor at the University of Virginia. “We don’t want to wait until patients start showing cognitive decline to take action.”
As a post-hoc analysis of clinical trial data, researchers said the study could not establish a causal relationship. The participants were adults with hypertension and high cardiovascular risk, so the results may not generalize to people at lower risk. Further research is needed to test clinically actionable thresholds and determine whether modifying the trajectory of vascular aging will reduce dementia risk.
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American College of Cardiology
