Routine blood pressure checks could help flag dementia risk, according to two studies tracking changes in blood vessel stiffness over time.
The findings add to growing evidence that uncontrolled high blood pressure may contribute to dementia by speeding up the ageing and stiffening of blood vessels.
Dr Newton Nyirenda is an epidemiologist at Georgetown University in Washington and lead author of the studies.
The researcher said: “Blood pressure management isn’t just about preventing heart attacks and strokes; it may also be one of the most actionable strategies for preserving cognitive health.
“We need to start thinking about hypertension management much earlier than we typically have in order to address this in younger adults before damage starts to accumulate.”
Rates of dementia and age-related cognitive decline are expected to rise as populations age.
At the same time, nearly half of US adults have high blood pressure, known as the ‘silent killer’ because many people do not know they have it.
Efforts to better tackle hypertension, a major cause of heart disease and a risk factor for dementia, could benefit both heart and brain health.
The 2025 ACC/AHA guideline on high blood pressure describes it as the most common modifiable risk factor for cardiovascular disease and for dementia linked to damage to blood vessels in the brain.
The two studies highlight risk scores that may help identify patients who are more likely to develop dementia.
One study found that pulse pressure-heart rate index, calculated from heart rate and blood pressure, independently predicted dementia risk in adults aged over 50.
A separate study found that adults with persistently raised or rapidly increasing estimated pulse wave velocity, a marker of vascular ageing calculated from age and blood pressure, were significantly more likely to develop dementia than those with more stable vascular profiles.
Nyirenda said: “Our findings suggest that vascular ageing patterns may provide meaningful insight into future dementia risk.
“This reinforces the idea that managing vascular health earlier in life may influence long-term brain health.’
The studies analysed 8,536 participants from the SPRINT trial, a large multicentre study of adults aged 50 and older with hypertension.
Over the follow-up period, 323 participants developed probable dementia. Researchers examined pulse pressure-heart rate index and estimated pulse wave velocity patterns over five years.
The results showed that participants with higher pulse pressure-heart rate index before the age of 65 had a significantly higher risk of developing probable dementia or mild cognitive impairment, a less severe form of memory and thinking problems.
Each unit increase in pulse pressure-heart rate index was associated with a 76 per cent higher risk. Participants with a higher estimated pulse wave velocity profile also had a higher risk of developing dementia, even after accounting for factors such as age, sex, kidney disease, cardiovascular history and smoking.
Since the components of pulse pressure-heart rate index and estimated pulse wave velocity are routinely measured at primary care visits, researchers said risk scoring based on either metric should be relatively easy to integrate into clinical workflows.
Dr Nyirenda said discussing dementia risk in these terms could encourage more patients to lower their risk through lifestyle changes and medication, if needed, to reduce blood pressure.
Dr Sula Mazimba, associate professor at the University of Virginia and senior author, said: “Clinicians should focus on individualising risk assessments and then tailoring treatment strategies that help patients improve cardiovascular health while preventing neurocognitive decline.
“You don’t want to wait until a patient starts manifesting cognitive decline before you act.”
