Hypertension is often associated with the heart, but because it involves arteries and blood vessels, its impact can be felt in many places, including the brain. The connection between blood pressure and brain health in elderly patients, while having been explored for decades, is still somewhat unclear.

As reported in Harvard Health Publishing (2019) “the weight of evidence now suggests that high blood pressure increases the risk of mild cognitive impairment, vascular dementia, and even Alzheimer's disease.”

Still, the full scope of research findings shows that there is little conclusive evidence yet to define the precise nature of the relationship between blood pressure and dementia – only that a relationship does exist. Home health care services – which can support BP monitoring and hypertension or hypotension management – may offer a measured and relevant response.

Exploring an unclear connection

Despite a suspected connection between hypertension and dementia that has been present for years, a recent (2020) Frontiers in Cardiovascular Medicine research review acknowledged a medical truth: “The optimal systolic and diastolic blood pressure values for protecting cognitive function, especially in elderly people, are not known.”

However, many studies over several decades have highlighted a connection between a decline in cognitive function and hypertension (a number of them focus on damage to small blood vessels in the brain that affect thinking and memory). “Hypertension seems to predispose to early cognitive deterioration,” claimed the Frontiers in Cardiovascular Medicine study quoted above, “which evolves to dementia and stroke after a time interval that may vary from a few to several years.”

Other studies have reported a range of both supportive and sometimes contradictory findings. What we are left with is one of the aforementioned study’s conclusions: “Most of observational studies have constantly showed that reducing high blood pressure has beneficial effects in lowering the risk of cognitive impairment and dementia.”

Blood pressure is positively associated with risk of vascular dementia, irrespective of preceding Transient Ischemic Attack or stroke.

A quantitative UK-based population study from Europe Pubmed Central determined the link between vascular dementia (the 2nd most common form) and high blood pressure. For those of us in the profession of home healthcare services, this finding reinforces the need to monitor blood pressure and relay data and changes to the patient’s cardiology care teams.

Other studies have reported a range of both supportive and sometimes contradictory findings. What we are left with is one of the aforementioned study’s conclusions: “Most of observational studies have constantly showed that reducing high blood pressure has beneficial effects in lowering the risk of cognitive impairment and dementia.”

77 percentage

Greater likelihood of dementia among men with elevated blood pressure

Heartbeat

A study quoted in Harvard Medical School’s Harvard Health Publishing {2019} said “a study of 2,505 men between the ages of 71 and 93 found that men with systolic pressures of 140 mm Hg or higher were 77% more likely to develop dementia than men with systolic pressures below 120 mm Hg.” At SeniorBridge, we believe that home healthcare services are in a position to 1. Help support the attainment and retention of health BP levels and 2. Monitor patients at home carefully for signs of dementia.

When hypertension hits home: 3 ways home healthcare can act

1. ADMINISTERING DIURETICS

Potassium-sparing diuretics, according to a Johns Hopkins report (published in Neurology) reduced the risk of Alzheimer’s in hypertension patients by almost 75%. Supporting diuretics as a way of controlling BP is a common task for home health professionals in a medically supervised care model.

2. MANAGING ANTIHYPERTENSIVE MEDICATIONS

The same Johns Hopkins study found that antihypertensive medications reduced risk of Alzheimer’s by around 33%.

3. COGNITIVE STIMULATION

The irreversible nature of dementia and the negative impact of medication side effects have resulted in a stronger focus on nonpharmacologic therapies. Specifically, a 2015 literature review showed that music therapy, light therapy, exercise, touch therapy, and other approaches led to this conclusion: “these interventions have important and significant efficacy improving…agitation, psychotic symptoms, and apathy. Undesired side effects of pharmacological treatments, such as antipsychotics and benzodiazepines, have promoted a search for alternative treatments for Behavioral and Psychological Symptoms of Dementia (BPSD). Therefore, nonpharmacological interventions programs should be considered as first-option interventions.”

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on hypertension home care support services, contact SeniorBridge.

Sources consulted:
Harvard Health Publishing (2019)
National Library of Medicine /NIH/Frontiers in Cardiovascular Medicine (2020)
National Library of Medicine /NIH/Europe PubMed Central (2016)
Johns Hopkins Medicine (2019)
National Library of Medicine /NIH/BioMed Research International (2015)

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