Blood pressure: Go low to improve memory
Friday, August 10, 2018
Pharmacists are in a unique position to promote patient adherence to blood pressure medication and to encourage self-monitoring of blood pressure, and now they have more reasons than ever.
For years we have known that lowering blood pressure helps prevent heart disease. In 2017, new guidelines from the American Heart Association (AHA) recommended treatment to begin for any patient with systolic blood pressure over 130 or diastolic over 80.
But a new study suggests that even lower numbers might be appropriate if we also want to lower the risk of mental decline.
The new study compared the benefits of lowering blood pressure to a systolic target of 120 rather than 140. Patients in the 120 group showed a 19 percent lower incidence of mild cognitive impairment. They also had fewer signs of damage to the brain compared to the group maintained at the higher blood pressure.
The results were presented in July at the Alzheimer’s Association International Conference in Chicago.
Dr. Jeff Williamson of the Wake Forest Baptist Medical Center in North Carolina led the study and calls it "a big breakthrough" and added, "It's more important than ever to work with your physician to ensure that you have good blood pressure control."
While a connection between elevated blood pressure and certain types of dementia has been demonstrated in the past, it has not been so clear that lowering blood pressure will actually reduce risk. This new study suggests it does, and this is a great incentive to speak up as pharmacists when our patients are picking up their medication for hypertension.
The study itself involved over 9,000 patients. Half were treated for a target of 120 systolic blood pressure (average was actually 121) and half were targeted for less than 140 (average was 135).
It was this very same study, officially stopped in 2015, that lead to the new AHA guidelines published in 2017. But assessment of cognitive results continued in patients after 2015 for 2 more years. And it is these remarkable results that were recently released.
It is too soon to say that aggressively lowering blood pressure will actually reduce the risk of Alzheimer’s disease. Study co-author Dr. Zoe Arvanitakis stated, "while our findings may eventually have important public health implications for blood pressure recommendations for older people, further studies will be needed to confirm and expand on our findings before any such recommendations can be made."
As pharmacists we dispense medications for blood pressure every day. No wonder, as over 100 million people in the United States have hypertension, nearly half of all U.S. adults.
Dr. Paul Muntner, a co-chair on the group that wrote the latest AHA Heart Disease and Stroke Statistics update, says, "With the aging of the population and increased life expectancy, the prevalence of high blood pressure is expected to continue to increase."
The results of this study provide a great opportunity to talk with our patients about their medications. Concern over memory decline is significant, especially among older adults.
While we can’t exaggerate the findings, it is fair to say that a lower blood pressure correlates with reduced risk of mental decline. That should be good news to many patient and an incentive to take their medication as directed.
Because the benefits were seen at an even lower systolic blood pressure than their physician may be targeting, it is a great time to suggestion self-monitoring of blood pressure as well. If patients who are controlled at systolic pressures above 130, they may want to talk to their doctor about ways to target 120 going forward.
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