The link to stroke and dementia

By age 40, more than half of Americans have hypertension, also known as high blood pressure, often without knowing it. Although the condition rarely causes noticeable symptoms, it can steadily damage blood vessels and organs.

When left untreated, hypertension can cause heart disease, which remains the top killer [VL1] of men and women in the United States. Hypertension also raises the risk of kidney disease and, increasingly, dementia. Research shows high blood pressure can damage the brain's small blood vessels, accelerating cognitive decline.

Patient stories drive home the stakes. George Solomon, a retired law enforcement officer, ignored medical advice to take blood pressure medication because he "felt fine." At 63, he suffered a stroke.

"I went upstairs to watch TV, and when I sat down in the chair, I couldn't get back up," Solomon said. He lost feeling in his arm and leg before being rushed to Duke University Hospital. After treatment and rehab, Solomon estimates he's recovered 80% and takes medication now. "I feel I'm on the right path," he said.

Doctors say Solomon's case is a common one. "There's a really enormous preventive health opportunity in treating hypertension earlier," said Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania. "If you catch it early, and treat it early, you can end up with many more years of healthy life expectancy."

Expert guidance

The American Heart Association's latest guidelines recommend action once blood pressure rises above 130/80 mm Hg. For people in the 130s, lifestyle strategies are the first line of defense: cutting sodium, exercising regularly, limiting alcohol, and managing stress with yoga, meditation, or deep breathing.  

"In hypertension, we haven't seen anything new that's effective since the '90s," Cohen said. However, there may be promising new treatments in the works.

For example, a new study published in the New England Journal of Medicine found that a medication called baxdrostat effectively lowered blood pressure in patients who had difficulty controlling their hypertension. Baxdrostat works by blocking aldosterone, a hormone that regulates fluid and sodium. High levels of aldosterone are a known driver of hypertension.

"What we saw is that after 12 weeks of treatment, there was about a 10-point improvement in blood pressure in the patients treated with baxdrostat over the placebo effect," said Jennifer Brown, a cardiologist at Brigham and Women's Hospital and one of the study's investigators.

That 10-point reduction in systolic blood pressure can make a big difference; it is linked to a roughly 20% reduction in the risk of heart attack and stroke, along with a lower risk of dementia. AstraZeneca, which sponsored the trial, plans to share the findings with regulators, potentially paving the way for the first new class of hypertension medications in decades.

For patients like Solomon, medications — along with lifestyle changes — are the difference between a silent threat and a healthier future.