High Blood Pressure at Age 50 Tied to Dementia Risk

According to Dr. David Perlmutter, neurologist, "a recent study published in the journal Neurology. They studied a group of 1,633 participants (with an average age of 53) by looking at their blood levels for various markers of inflammation. After 24 years, the participants underwent a special brain scan to measure the size of various areas of the brain. The study revealed a marked correlation between midlife elevation of inflammatory markers and reduction in size of key brain areas including the hippocampus, the brain’s memory center. " Now, looking at the systolic blood pressure of the 1,633 participants, there are not much difference of the systolic blood pressure between low level of inflammation group (115.8) and high level of inflammation group (116.8). This may suggest inflammation is not the big factor for the systolic blood pressure level. And, yet, inflammation level at midlife shows marked correlation with the brain shrinkage in older age. This may hint that checking the inflammation level at midlife may be better way than checking the blood pressure at midlife to prevent dementia in older age. Also there are more researches that connect inflammation to dementia/Alzheimer's rather than blood pressure.

The final quote is what causes me concern. Don’t lose weight, watch your alcohol intake, get exercise, eat a balanced diet and avoid smoking, just take your meds

Difference in absolute risk, please.

Am I the only one? Or is it my rusty memory of statistical methods , but what leaps out of Table 2 of the study, is the overwhelming low status, low education and incidence of atrial fibrillation in the dementia population. Early high blood pressure looks to me like the least problem. What if the afflicted patients had dangerous low paying manual jobs? One could also conclude from the same table, that heavy drinking (2 drinks a day, give me a break!) protects against dementia! And an attrition rate of nearly 50 %! This looks like another case, where numbers get massaged till they produce the desired statistics.

According to Dr. Dale Bredesen, a pioneer researcher and therapist of MCI and early Alzheimer’s patients, there are 36 causes and 26 treatments. Usually his patients come with 10-15 causes altogether when they visit him. Since Alzheimer’s takes years to show symptoms such as brain shrinkage, increasing Amyloyd plaques and tangles, he recommends to take so-called “ cognoscopy test” at the age 45 and over in order to rectify past lefestyle by diet, supplements, sleep, exercise, hormonal balancing etc. 36 causes are put together into 3 groups; inflammation , deficit of vital nutrients and hormones for brain, and toxins. Probably causes of high blood pressure at 50 yearls old and causes of dementia , mostly Alzheimer’s, in later years are same, and not one but many. Dr. Bredesen has shown the evidences that 26 therapies instead of a miracle drug can treat early Alzheimer’s patients. We had better understand his remarkable contribution to the Alzheimer’s disease.

"Tied to dementia" is far too strong and recalibrating thresholds for blood pressure reducing drugs is not a conclusion that any responsible clinician should draw. First of, we are diagnosing far more cases of hypertension probably because we keep lowering the bar for defining blood pressure as "high". Second, incidence rates of dementia in the population are actually declining, fast. Third, anti-hypertensives have side effects such as depression in the case of beta blockers and kidney damage in the case of ace inhibitors. They are far from safe and innocuous. Fourth, the association between blood pressure and dementia is just that, a minor association that in and of itself tells us nothing about causality. Take a very simple example: high blood pressure is associated with kidney damage; but then kidney damage is associated with high blood pressure. Is it regulation within the kidney that is critical to blood pressure or is blood pressure critical to kidney health? Or do we have some delicate, complex dance going on here? Or are kidneys and blood pressure both responding to something else, a change in neurologic regulation from the brain or in signalling from neurotransmitters and hormones (the former sometimes behaving as the latter and vice versa)? In other words, it's complicated. Deriving a therapeutic guideline or advice to patients from associational evidence is irresponsible. No wonder so many think clinical decisions are being driven by drugs companies.

Shift work is a known cause of HBP. It's too much to try to go to a gym after working all night. You have to sleep, sometime. And those double-shifts! I used to nurse, and it was so common to be forced into overnight doubles. Day after day. That gave me high blood pressure. And then, there's so much salt in everything. When I started watching salt, I was dismayed to see enormous amounts in all sorts of unexpected foods. Also, I found doctors ignored me when I said I had high blood pressure and wanted pills. I was thin, so couldn't be true--until I ended in the ER with it. Oh, then I was scolded for not taking care of it!

Says the research scientist: "I would encourage people to use their hypertensive medications.” In contrast, I would encourage people to improve their lifestyles: eat better and exercise more. Specifically, eat more whole foods ( = unprocessed) plant based ( = no animal products). Lots of veggies and fruits, beans and whole grains, and seeds and nuts in moderation. Cook at home. A prescription for meds is, for most people, a permission slip to continue unhealthy habits.

So why is blood pressure elevated? Instead of using medication to lower blood pressure, why not address the root cause of the condition - say, hyperinsulinemia or metabolic syndrome?

This study is an interesting starting point but only that. Remember association is not causation. It may be that high blood pressure is not the cause of dementia but merely a marker; i.e. another physical condition like metabolic disorder causes both high blood pressure and dementia. Another possibility is that the medical response to high blood pressure is the causal factor, since high blood pressure is treated with drugs in a high percentage of cases. Maybe blood pressure meds reduce risk of stroke and heart attack but increase the chance of Alzheimer's. As somone who takes blood pressure medication, I hope this isn't the case.

I've heard reference to this before. It worries me because I am in this category. My question is what can I do to minimize my fist at current age of 62?

A 38% increased risk of dementia corresponding to a hazard ratio of 1.38 may not be clinically relevant and in a small study population, a hazard ratio less than 2.0 would not be worth this sort of emphasis (http://www.statisticshowto.com/hazard-ratio/). We need to distinguish "statistically significant" from clinically relevant.

No, we don't take our meds because we can't afford them. Stop confusing non-compliance with unaffordability. And rather than pushing medication at everyone how about advocating for less stress for everyone. Medication doesn't make a good substitute for lives that are less stress filled, that can't include regular exercise, have no down time at all because of employer demands that we be on 24/7, or when we're unemployed and worried about finding a job, paying the bills, etc.