Maintaining a systolic blood pressure of 120 or less may protect against dementia and cognitive decline. Nearly two-thirds of adults living in the United States have hypertension (high blood pressure), defined as having a systolic pressure of 130 or higher or a diastolic pressure of 80 or higher. Hypertension damages small blood vessels in the eyes, kidneys, and other tissues, increasing the risk for disease and dysfunction. A 2019 study found that intensive blood pressure control in patients with hypertension reduces the risk of developing small blood vessel damage-related white matter lesions in the brain.

Intensive blood pressure control is an aggressive treatment protocol for hypertension that seeks to achieve a target systolic blood pressure goal of 120 or less. This differs from standard treatment protocols, which stipulate that within three months of starting medication therapy to reduce high blood pressure, a patient’s target pressures (systolic and diastolic) should be less than 140/90. After three months, the target pressures should be less than 130/80.

White matter lesions are areas in the brain that appear as intense white spots on magnetic resonance imaging (MRI) scans. They are often indicators of small blood vessel disease and are considered a risk factor for dementia.

The study involved 670 adults (average age, 67 years) who had hypertension. Roughly half of the participants underwent intensive blood pressure control treatment, while the other half underwent standard treatment. The investigators performed MRI scans of all participants at the beginning of the intervention and again about four years later.

They found that participants who underwent intensive blood pressure control had fewer white matter lesions in their brains compared to those who underwent the standard treatment. Interestingly, those who underwent intensive treatment exhibited greater brain volume losses than those who underwent standard treatment, but this difference was not statistically significant.

These findings suggest that intensive blood pressure control reduces white matter lesions in the brains of people with hypertension and support findings from a related study that demonstrated that intensive blood pressure control may reduce the risk of adverse cognitive outcomes.

Hypertension is highly preventable with lifestyle modifications that involve diet and exercise. For example, dietary components, such as potassium and magnesiumquercetin and vitamin D lower blood pressure. Aerobic exercise also lowers blood pressure. Learn about other beneficial effects of aerobic exercise in our overview article.

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