Under Pressure: Managing Blood Pressure to Protect Your Brain

Written By Jennifer Palmquist

We often think about blood pressure in terms of heart attacks or strokes, but have you considered its impact on your brain? Your heart health and your brain health are so closely related that the American Heart Association has declared “what’s good for the heart is good for the brain.”

Hypertension (high blood pressure) is often called the “silent killer” because it poses a large threat to both heart and brain health but it often has no symptoms. Untreated high blood pressure in midlife is one of the major modifiable risk factors for dementia, according to decades of research and the 2024 Lancet Commission on dementia. The good news is that there are plenty of things you can do to control your blood pressure and taking those steps now can significantly lower your risk of cognitive decline later. 

If you’re already working on your brain health – eating nutritious foods, staying physically active, maybe tackling Sudoku or Wordle each morning - keep up the good work and consider adding managing your blood pressure to your brain healthy habits. Let’s explore why managing your blood pressure number is so crucial for your brain, and how you can take action.

But it's important to remember, this is only one of many modifiable behavioral risk factors for Alzheimer's and dementia. 

If you'd like a personalized plan, daily activities and support to help address all of your most pressing risks, sign up for a 2 week free trial of Mindr. Better brain health starts today. 

If you'd like a personalized plan, daily activities and support to help address all of your most pressing risks, sign up for a 2 week free trial of Mindr. Better brain health starts today. 

How High Blood Pressure Hurts the Brain

Your brain relies on a constant rich blood supply to deliver oxygen and nutrients. High blood pressure, especially over many years, can damage the delicate blood vessels that nourish the brain. Think of it like high-pressure water hammering through old pipes – over time, it causes wear and tear. Hypertension stiffens arteries and can lead to clogged blood vessels, reducing blood flow to brain tissue. 

The result? Brain cells chronically undersupplied with blood may become damaged or die. This vascular damage is one reason hypertension is strongly linked to vascular dementia. Even for Alzheimer’s disease, which has complex causes, long-term high blood pressure is believed to contribute by harming brain blood vessels and compounding problems caused by other conditions like high cholesterol and diabetes.

The statistics around blood pressure and dementia are eye-opening. A longitudinal study by Johns Hopkins found that people who had hypertension in midlife and later life were 49% more likely to develop dementia than those with normal blood pressure throughout. In fact, having uncontrolled high blood pressure by your 40s or 50s and carrying it into older age appears particularly risky. Blood pressure in your 30s, 40s and 50s can influence brain health decades down the line. One study noted that individuals with midlife hypertension who later experienced a drop to very low blood pressure in old age had an even higher dementia risk. The takeaway: the damage from high blood pressure accumulates over time, so the earlier you get it under control, the better for your brain.

In addition to the cumulative damage high blood pressure can inflict, it is a leading cause of strokes. A stroke is essentially a brain attack during which blood flow to part of the brain is temporarily disrupted. Having a stroke nearly doubles the chances of later developing dementia. Up to 90% of strokes are preventable, largely by managing vascular risk factors like high blood pressure. 

Even “silent” mini-strokes that you might not notice at the time can steal a bit of cognitive function each time they happen. All of this explains why the Lancet Commission and other experts include hypertension on the modifiable risk factor list for dementia, and why they emphasize keeping blood pressure in check as a key brain-protective strategy. In short, what’s bad for your heart is bad for your brain – and high blood pressure is very bad for both.

Why Treating Hypertension Helps Your Brain

Managing your blood pressure can pay off with real benefits for your cognitive health. We have growing evidence that treating hypertension not only protects your heart, but also your memory and thinking. For example, the SPRINT MIND trial – a large NIH-led study – found that aggressively controlling systolic blood pressure (targeting 120 mmHg instead of 140) led to a significant 19% reduction in cases of mild cognitive impairment (MCI), a precursor to dementia. The trial didn’t run long enough to conclusively prove fewer dementia cases, but the drop in MCI is a strong sign that better blood pressure control slows cognitive decline. This was a landmark result: it’s one of the first randomized trials showing a clear brain benefit from a blood pressure intervention.

Observational studies back this up. The Alzheimer’s Association reports that among people with high blood pressure, those who take antihypertensive medication have a lower risk of developing dementia later on compared to those who leave it untreated. Essentially, if you have hypertension, treating it reduces the harm to your brain and decreases your risk of dementia closer to someone without high blood pressure. 

High blood pressure does not doom you to cognitive decline, as long as you take steps to control it. In fact, experts estimate that widespread public health action on preventing and treating hypertension could significantly cut future dementia rates. Your brain stands to gain a lot from blood pressure control.

Given this knowledge, the Lancet Commission’s 2024 report explicitly recommends maintaining a systolic blood pressure of 130 mmHg or less from age 40 onward to reduce dementia risk. That’s more strict than older guidelines for general heart health, which underlines new knowledge about how crucial midlife blood pressure is. 

It’s not about stressing about exact numbers though. It’s about avoiding years of uncontrolled high pressure that silently damages your brain’s infrastructure. Every bit you improve your blood pressure – through lifestyle changes or medications – translates into healthier brain aging.

Take Charge: Keeping Your Blood Pressure Brain-Friendly

Controlling blood pressure is one of the most powerful things you can do for your long-term brain health. It’s never too early or too late to start. Here are some actionable steps and tips to help you take control of your blood pressure:

  • Know Your Numbers: First, get a handle on what your blood pressure actually is. Normal is around 120/80; hypertension is typically 130/80 and above, according to current guidelines. Many people have no symptoms of high blood pressure so measurement is the only way to know. Knowing your baseline helps you and your doctor make a plan. Home blood pressure monitors are affordable and easy to use – consider getting one so you can track your readings. As the American Heart Association puts it, “know your numbers” for blood pressure (and other risk factors like cholesterol and blood sugar) – these are key to managing your health.

  • Heart-Healthy Lifestyle: What’s good for your heart truly is good for your brain. Tackle blood pressure with popular heart-healthy lifestyle approaches: eat a balanced, low-salt diet, stay physically active, maintain a healthy weight, and limit alcohol. Emphasize fruits, vegetables, whole grains, and lean proteins using the DASH diet which was literally designed to fight high blood pressure and cut back on excess sodium. Regular exercise (even brisk walks) makes your heart and arteries more elastic, which lowers blood pressure. These habits can often prevent mild hypertension from escalating or even bring high blood pressure down into normal range without medications. Plus, physical activity and good nutrition have direct brain benefits too!

  • Stress Management and Sleep: Chronic stress and poor sleep can nudge blood pressure upward over time. Finding ways to relax – whether through mindfulness meditation, yoga, nature walks, or hobbies – can help moderate your blood pressure. Aim for quality sleep (7–8 hours for most adults) since sleep apnea and sleep deprivation are known to worsen hypertension and harm cognition. If you snore heavily or feel very tired in the daytime, talk to your doctor. Treating sleep apnea can improve blood pressure control and possibly protect your brain.

  • Take Prescribed Medications if Needed: If your doctor has prescribed blood pressure medication, take it consistently. There are many safe, effective blood pressure medications available (diuretics, ACE inhibitors, ARBs, calcium blockers, etc.), and they work. Taking medicine to control blood pressure when lifestyle changes aren’t enough isn’t failure; on the contrary, it’s a powerful way to take charge of your health. Work with your healthcare provider to find the right medication with minimal side effects. And keep in mind the encouraging research: treating hypertension with medication is associated with reduced dementia risk later on. Essentially, you’re removing that extra risk factor. Always follow your doctor’s guidance, and never stop blood pressure medications abruptly on your own.

  • Stay Consistent with Check-ups: High blood pressure which was under control can sneak back up. Since it often exists without symptoms, it’s important to continue to monitor your blood pressure at home and to visit your doctor for regular check-ups, especially if you’re middle-aged or older. Adjustments to your treatment plan (lifestyle or medications) may be needed over time. By staying on top of it, you ensure your blood pressure remains in a brain-friendly range. Remember, the goal of under 130/80 (or a target your doctor gives you) is there to protect your brain, not just to impress your cardiologist. 

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A Low Pressure Approach

Small steps absolutely add up. Maybe start with a daily walk or swapping out salty snacks for fresh fruit. Celebrate each improvement, like a few points off your blood pressure reading or a healthier meal choice. Your choices today actively reduce your risk of memory loss and dementia in the years ahead. 

Hypertension has been called a silent killer, but with awareness and action, you can silence it instead. Take steps to protect your heart, brain, and future. You’ve got the power to keep your blood pressure in check, and by doing so, keep your mind sharp and clear for the long run.

What’s Next?

Managing blood pressure might sound daunting, but it’s very achievable – and you don’t have to do it alone. Mindr can help! Many studies, including the U.S. POINTER trial, a study of lifestyle changes conducted by the Alzheimer’s Association, have shown that coaching support and structured intervention plans give people a statistically significant edge over those who are self-guided. 

With Mindr, you will have access to all of these success boosting tools:

  • An easy to follow personalized blood pressure reduction plan that fits your life

  • Additional personalized plans for your most pressing risk factors

  • Daily guidance so you know exactly what to do each day

  • Frequent assessments and tracking so you can see your progress

  • A human in the loop to support and encourage you

You wouldn’t still be reading this if having a healthy brain wasn’t important to you. The lifestyle changes that will get you there are within your reach. You have the will, we’ll show you the way - one day at a time. You can do this and we can help.

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References: 

Jennifer Palmquist
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