Hypertension affects two-thirds of people aged >60 years and significantly increases
the risk of both vascular cognitive impairment and Alzheimer's disease. Hypertension
compromises the structural and functional integrity of the cerebral microcirculation,
promoting microvascular rarefaction, cerebromicrovascular endothelial dysfunction
and neurovascular uncoupling, which impair cerebral blood supply. In addition, hypertension
disrupts the blood-brain barrier, promoting neuroinflammation and exacerbation of
amyloid pathologies. Ageing is characterized by multifaceted homeostatic dysfunction
and impaired cellular stress resilience, which exacerbate the deleterious cerebromicrovascular
effects of hypertension. Neuroradiological markers of hypertension-induced cerebral
small vessel disease include white matter hyperintensities, lacunar infarcts and microhaemorrhages,
all of which are associated with cognitive decline. Use of pharmaceutical and lifestyle
interventions that reduce blood pressure, in combination with treatments that promote
microvascular health, have the potential to prevent or delay the pathogenesis of vascular
cognitive impairment and Alzheimer's disease in patients with hypertension.
