From this point of view, 85 x 160 is good

An Israeli study strengthens the hypothesis that people aged 70 and over who have high blood pressure show better cognitive ability than their peers with blood pressure that is considered normal

Merit Sloin

There is no debate that low blood pressure is good for health. Western society fights to lower blood pressure by various means, knowing that high blood pressure is a major risk factor for cardiovascular disease, stroke and kidney disease. But according to a new study by scientists from Ben Gurion University of the Negev and Soroka Hospital, lowering blood pressure may have negative consequences. It turns out that in the elderly, blood pressure that is considered normal causes a significant decrease in cognitive ability, which affects the quality of life.

During the 90s, studies were conducted that examined the effects of hypertension treatment on adults and the elderly. The most prominent finding in the studies indicated a significant decrease in the incidence of cerebrovascular events and heart diseases, which resulted in a decrease in patient mortality. Another finding was that a decrease in blood pressure at the age of 70-50 is also accompanied by a decrease in the number of dementia cases. Based on these findings, the American health authorities have lowered the normal blood pressure values ​​for all ages to below 140/90 in recent years.

However, at the same time, a debate began that focused on the effect of blood pressure on cognitive ability. The claim was that a drop in blood pressure lowers the speed of blood flow in the brain and therefore may increase cognitive impairment in adults and the elderly.

A team of Israeli researchers - which included Prof. Esther Fern from the Hypertension Unit at Soroka Hospital, Prof. Ofra Anson from the Rekanti School of Health Sciences and Dr. Haim Reuveni from the Department of Health Policy, from the Faculty of Health Sciences at Ben Gurion University - decided to examine the question thoroughly. "The idea to examine the issue arose about eight years ago, when recommendations were published by the US health authorities to lower the desired blood pressure values ​​in the elderly over the age of 65. The reason for this was findings that showed that low blood pressure at this age reduces morbidity and mortality from cardiovascular diseases, and from events brain Other studies, which focused on cognitive functions, showed that high blood pressure between the ages of 50 and 70 apparently increases the chance of dementia later on," says Fern. "But when we started to check the medical literature, we found that the results are not conclusive. There was no work that thoroughly examined the relationship between blood pressure and various cognitive functions in the elderly."

The team conducted a study on a group of 495 elderly men and women, whose average age was 77. A team that included an interviewer and a nurse came to the home of each of the study participants. Each participant filled out a questionnaire with questions that tested their medical and cognitive status. To assess the cognitive state, the researchers tested the short and long term memory, the visual memory, the ability to concentrate and the fluency of speech. The interviewee's blood pressure was then measured three times. Blood pressure above 140/90 was defined as high blood pressure.

The team divided the respondents into four groups: people with normal blood pressure values; People whose blood pressure values ​​were normal after drug treatment; People with high blood pressure values ​​who have not received treatment; and people whose blood pressure was high even though they received treatment. "In the summary of the results, we saw a direct relationship between the blood pressure values ​​and the cognitive function of the elderly," says Fern. "The findings were surprising. The worst cognitive performance was precisely in the group of subjects with normal blood pressure values ​​and in the group whose blood pressure was controlled and balanced by medication. In contrast, the patients who did not respond to treatment or were not treated and their blood pressure reached average values ​​of 158/85, showed the best cognitive abilities."

"These findings raise the possibility that low blood pressure in the elderly causes disruptions in cognitive ability. In other words: high blood pressure actually protects cognitive ability after the age of 70", write the researchers in an article published last month in the "Hypertention American Journal of".

How can these findings be explained? How is it possible that up to the age of 70, high blood pressure damages cognitive ability and increases the risk of dementia, while in those 70 and older, high blood pressure prevents cognitive deterioration? "In people aged 70-50, high blood pressure can cause small infarcts in the brain. These infarcts are not manifested in sensory disorders, but they may cause a decrease in intelligence and memory because they damage the associative connections in the brain. That is why it is recommended at these ages to lower the blood pressure," Fern explains.

"In elderly people aged 70 and over, this risk still exists, but its effect on intellectual ability is not central. The decisive factor in this regard is the rate of blood supply to the brain. At the age of 70, the blood flow is slow due to the deposits that accumulate in the blood vessels. Low blood pressure may slow down the flow even more and cause areas of the brain to not receive a proper blood supply, which may cause a state of confusion and sometimes even delirium."

There are still no studies outlining a clear treatment line and guiding doctors on how to weigh the various effects of lowering blood pressure in the elderly. "It is clear to us that in terms of stroke and heart disease the recommendation is to lower blood pressure, but cognitively it turns out that normal and low blood pressure in the elderly can be harmful. This is the price we pay for prolonging life."

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