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Can High Blood Pressure Cause Dementia? What to Know
New research says hypertension in midlife increases risk of memory loss, while aggressive control of blood pressure can reduce risk
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Here’s another reason to keep your blood pressure in check (not that you need one): Doing so can reduce your risk of dementia. That was the message from some of the strongest evidence to date linking the two.
In a study published recently in the journal Nature Medicine, researchers tracked the blood pressure patterns of almost 34,000 people with uncontrolled hypertension in rural China to see if reducing their blood pressure would also reduce their risk of dementia. The average age of the participants was 63.
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About half received treatment for high blood pressure — a combination of medication, lifestyle changes and coaching — while the other group received usual care (they received regular blood pressure management by their health care providers, but no lifestyle coaching or home monitoring). After four years, the participants who brought their blood pressure under control — below 130/80 millimeters Hg (mercury) — had a 15 percent lower chance of being diagnosed with dementia and 16 percent lower chance of cognitive impairment compared with the group that didn’t receive the intensive treatment.
The key was more aggressive blood pressure control, says the study’s lead author, Dr. Jiang He, professor and chair of epidemiology at the UT Southwestern O’Donnell School of Public Health.
Researchers have long known that high blood pressure can increase your risk of developing heart disease or having a stroke. More recently, they’ve zeroed in on how it also ups your chances of getting dementia and its common predecessor, mild cognitive impairment (MCI). These links have been recognized for a while; observational studies have shown that people with high blood pressure are at greater risk of developing dementia and MCI, and that taking blood pressure medication may help reduce those risks. But few, long-term studies have shown those effects to be significant until now, notes He: “In our randomized trial, participants achieved substantial blood pressure reduction and a statistically significant reduction in all-cause dementia.”
What happens in the brain when blood pressure is high?
“Elevated blood pressure damages the small arteries that supply the brain,” says He. “Over time, this leads to stiffening, narrowing and sometimes blockage of these vessels, reducing cerebral blood flow.”
And damage to those small vessels in the brain is strongly linked to cognitive decline and dementia. “There is also evidence that vascular injury from hypertension may worsen the [accumulation] of amyloid and tau,” He says. When those two proteins form plaques and tangles in the brain, it’s a hallmark of Alzheimer’s disease, the most common cause of dementia. All of these changes can lead to difficulties with various cognitive functions, including memory, processing speed, executive function and language skills.
A new goal for normal blood pressure
Normal blood pressure is defined as 120/80 mm Hg, according to new guidelines from the American Heart Association (AHA), while hypertension is any reading over 130/80 mm Hg. The difference between 120 and 130 may not sound like a lot, but “small changes in blood pressure can have big changes in outcomes,” says Dr. Mitchell Elkind, the AHA’s chief science officer for brain health and stroke.
A change in systolic blood pressure of 5 mm Hg is associated with a 13 percent reduction in the risk of stroke and about a 10 percent reduction in the risk of other cardiovascular events, Elkind says. “So, the difference between 120 mm Hg and 130 mm Hg can be considered roughly twice that, or a reduction in stroke risk of about 26 percent and a reduction in other events of about 20 percent.” Cutting stroke risk is an important way to cut dementia risk, as strokes are often a precursor to dementia.
How can you keep your blood pressure in check?
The AHA outlines benchmarks for how to achieve a normal blood pressure reading: maintain a healthy weight, exercise regularly, manage stress, limit alcohol and sodium. Your doctor may recommend medication, as well.
“Monitor your blood pressure and take it seriously throughout life,” says Dr. Gary Small, professor and chair of psychiatry at Hackensack Meridian School of Medicine. “And try to keep it in the normal range, whether it’s through medications, lifestyle modifications or both.”
If you end up taking medication to reduce hypertension, it’s important to monitor your blood pressure closely to make sure it stays in the normal range—especially if you had high blood pressure at midlife and develop low blood pressure later on, which can happen when hypertension is overtreated with medication.
“Overtreatment of hypertension in middle-aged and older adults may reduce circulation of blood throughout the brain; as a result, the brain doesn’t get enough oxygen and its main energy source, glucose,” adds Small, echoing research suggesting that a pattern of high blood pressure during middle age followed by low blood pressure in later years is associated with an increased risk of dementia.
“Reducing one’s risk [for high blood pressure] earlier in life is important, since the changes that lead to dementia start earlier in life than previously appreciated,” Elkind says. “It’s never too early to start checking blood pressure and treating hypertension.”
This article was updated on September 9, 2025, to add new research findings.
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