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Can High Blood Pressure Reduce Risk of Alzheimer's?

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Can High Blood Pressure Reduce Risk of Alzheimer's? about undefined
We've been getting some real health shocks in recent years. The first came when studies showed people with high cholesterol are more intelligent, have a reduced risk for dementia, and live longer. Then, three major studies demonstrated that being overweight or even obese can be protective against dementia. Now, a new study has thrown the cat among the pigeons. It suggests hypertension (high blood pressure) can substantially reduce the risk of Alzheimer's under some circumstances. The reasons for these seemingly paradoxical findings have to do with your age…

Hypertension May Have a Benefit If You’re Over 80

For the blood pressure study, 559 people aged 90 or over without dementia were included in a long-term study that began in 1981. During the follow-up period of nearly three years, 224 developed dementia. Compared to those who did not have hypertension, the ones who developed the condition in their 80s had a 42% lower dementia risk, while the risk reduction for those past 90 years of age was 63%. The study, published in Alzheimer's & Dementia in January 2017, concluded that "Developing hypertension at older ages may protect against dementia." This is the same hypertension that can cause blood vessels in the brain to leak, narrow, or become blocked. The damage caused by high blood pressure reduces blood supply and leads to cell death. This, in turn, creates brain lesions called white matter hyperintensities, resulting in problems with thinking, reasoning, and memory. So, what is the explanation for the protective effect of high blood pressure if it begins late in life?

Improved Blood Flow to the Brain

Lead author Maria Corrada, Professor of Neurology at the University of California, Irvine, suggested this explanation: "We believe that it may be because blood vessels become stiffer with age [and] a high blood pressure is needed to pump blood to the brain. It's a matter of creating enough pressure to get blood to oxygenate the brain adequately." Her sentiments were echoed by Dr. Sam Gandy, Professor of Neurology and Alzheimer's Disease Research at Mount Sinai Hospital in New York. He believes high blood pressure should be divided into at least two types. "We usually think of the young adult-onset form, which, if untreated, can damage heart, kidney, eye, and brain blood vessels. "A second class may be late-life hypertension, which is driven by a brain in distress. This distressed brain, through neurological mechanisms, could be causing blood pressure to rise in an attempt to improve blood flow and relieve distress."

Risk Factors May Depend on Your Age

Dr. Maria C. Carrillo, Chief Science Officer at the Alzheimer's Association, commented on the findings by saying that "some risk factors for dementia may change over the course of our lives." In other words, strategies that apply to one age group may not relate to another. This would also explain why attempts to treat late-life hypertension have not reduced the incidence of dementia. Biological changes that come with aging mean recommendations may have to be adapted according to whose needs are being addressed. Attempting to control high cholesterol in older people may be a bad idea when cholesterol is needed to protect against cancer, a disease that becomes more likely with age, and infectious diseases like pneumonia, which older people are more susceptible to. Being overweight may also be beneficial at a certain age because fat reserves are an important source of energy and aid immunity. Extra pounds may offer protection when you fall ill and help with recovery. The operative word there is "may." Don’t go on an eating binge because you read somewhere that fat is now okay. It’s not.

Does This Mean Anything for Patients Right Now?

First, one blood pressure study doesn’t settle a complicated question like this. Results may vary from one study to the next. As far as I know, no doctor has tried to apply this blood pressure finding in his practice. It sounds like a rise in blood pressure that begins after age 80 should be observed and monitored, not treated with drugs. I’m no fan of drug treatments for high blood pressure anyway. A daily walk and meditation (or related practices) should be tried first.
Another problem is that high blood pressure is over-diagnosed and over-treated. The medical profession has set the bar quite low, and what was considered a healthy blood pressure is now considered a disease. As in many things, don’t be sure the MDs know what they’re talking about. It’s unclear that science is on the side of the new benchmarks – which have greatly benefited the big drug companies. Just by coincidence, I’m sure. Dr. William Campbell Douglass, a famous medical maverick, used to maintain that high blood pressure was a danger only if it was extremely high. Most cases of so-called high blood pressure, he said, should be left untreated. I don’t know if science is on his side, either, but I suspect if you’re healthy in general, then your blood pressure, whatever it is, will be healthy as well. Take a walk, put the cookie down, take a vitamin, and learn to relax: good advice at all times and all places. It's also a good idea to monitor your blood pressure on your own. Monitoring your blood pressure at home beats doing it in the doctor's office, hands down.
  1. Mielke MM, Zandi PP, Sjögren M, Gustafson D, Ostling S, Steen B, Skoog I. High total cholesterol levels in late life associated with a reduced risk of dementia. Neurology. 2005 May 24;64(10):1689-95. doi: 10.1212/01.WNL.0000161870.78572.A5. PMID: 15911792. https://www.ncbi.nlm.nih.gov/pubmed/15911792
  2. Elias PK, Elias MF, D'Agostino RB, Sullivan LM, Wolf PA. Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosom Med. 2005 Jan-Feb;67(1):24-30. doi: 10.1097/01.psy.0000151745.67285.c2. PMID: 15673620. https://www.ncbi.nlm.nih.gov/pubmed/15673620
  3. Weverling-Rijnsburger AW, Blauw GJ, Lagaay AM, Knook DL, Meinders AE, Westendorp RG. Total cholesterol and risk of mortality in the oldest old. Lancet. 1997 Oct 18;350(9085):1119-23. doi: 10.1016/s0140-6736(97)04430-9. Erratum in: Lancet 1998 Jan 3;351(9095):70. PMID: 9343498. https://www.ncbi.nlm.nih.gov/pubmed/9343498
  4. Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, Evans SJW, Pocock SJ. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol. 2015 Jun;3(6):431-436. doi: 10.1016/S2213-8587(15)00033-9. Epub 2015 Apr 9. PMID: 25866264. https://www.ncbi.nlm.nih.gov/pubmed/25866264
  5. Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L. Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project. J Am Geriatr Soc. 2008 Jan;56(1):111-6. doi: 10.1111/j.1532-5415.2007.01458.x. Epub 2007 Nov 20. PMID: 18028342. https://www.ncbi.nlm.nih.gov/pubmed/18028342
  6. Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L. Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project. J Am Geriatr Soc. 2008 Jan;56(1):111-6. doi: 10.1111/j.1532-5415.2007.01458.x. Epub 2007 Nov 20. PMID: 18028342. https://www.ncbi.nlm.nih.gov/pubmed/19273752
  7. http://www.dailymail.co.uk/health/article-3037550/How-love-handles-help-live-longer-astonishing-new-research-shows-overweight-help-ward-dementia.html
  8. Corrada MM, Hayden KM, Paganini-Hill A, Bullain SS, DeMoss J, Aguirre C, Brookmeyer R, Kawas CH. Age of onset of hypertension and risk of dementia in the oldest-old: The 90+ Study. Alzheimers Dement. 2017 Feb;13(2):103-110. doi: 10.1016/j.jalz.2016.09.007. Epub 2017 Jan 17. PMID: 28108119; PMCID: PMC5318224. https://www.ncbi.nlm.nih.gov/pubmed/28108119

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