Hypertension and cognitive function. Blood pressure regulation and cognitive function: a review of the literature.

High blood pressure raises the risks of vascular dementia and cognitive dysfunction in older adults, by acting on the cerebral vasculature and directly on the brain itself. Clinical trials and observational studies have shown that treating hypertension to target (<140/90 mm Hg) not only lessens morbidity and mortality, but also improves quality of life and preserves cognitive function. Yet, only 34% of hypertensive Americans currently have their hypertension under control, despite widespread treatment. Although single drug therapy is effective in treating hypertension, most patients will require combination drug treatment. Combination therapy--typically a diuretic with an ACE inhibitor, an ARB, or a beta blocker--is appropriate for treatment of older patients, is well tolerated, and can effectively preserve cognitive function.