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Invited Commentary
April 2015

Blood Pressure Control and Cognitive Impairment—Why Low Is Not Always Better

Author Affiliations
  • 1Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
  • 2Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
  • 3Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
JAMA Intern Med. 2015;175(4):586-587. doi:10.1001/jamainternmed.2014.8202

The link between blood pressure and cognitive impairment is a complex beast. Several observational investigations have studied the association between blood pressure and cognitive function and yielded mixed results.1 Various explanations such as heterogeneity in demographic and clinical characteristics of study populations have been proposed for such discrepancies. Methodological limitations of clinical trials on antihypertensive therapy in relation to cognitive outcomes have added further complexity to this issue. While a meta-analysis of placebo-controlled trials showed a marginal benefit of lowering blood pressure in reducing the risk of dementia,2 the short-term follow-up and inclusion of healthy participants with low levels of comorbidities and high levels of cognitive functioning have limited the generalizability of these findings.3

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