Hypertension links to lower dementia risk in carotid disease

In adults aged 50 and older, researchers analyzed how hypertension relates to dementia outcomes in those with and without asymptomatic extracranial carotid atherosclerotic disease (aECAD). The study evaluated data from the prospective Carotids and Minds study and the US nationwide TriNetX database.

Among patients with aECAD, hypertension was significantly associated with higher cognitive scores (β = 0.47), lower pTau217 levels (β = -0.52), and reduced risks of Alzheimer's disease (HR = 0.56), non-AD dementia (HR = 0.66), and mild cognitive impairment (HR = 0.69). Risk reductions were strongest in patients 81 years of age and older. A systolic blood pressure between 140 and 159 mmHg optimized protective effects without a significant increase in major cardiovascular events and death. In contrast, hypertension was associated with higher dementia risk in adults without aECAD, and carotid endarterectomy mitigated the observed protection.