Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.

中文翻译：

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高血压、神经退行性疾病和认知能力下降

血压升高是与年龄相关的认知能力下降的一个公认的危险因素。长期以来，高血压与血管基础的认知障碍有关，越来越多的证据表明，高血压与阿尔茨海默病潜在的神经退行性病理学存在潜在关联。众所周知，高血压会破坏脑血管系统的结构和功能完整性。然而，这些改变导致脑损伤、增强阿尔茨海默病病理和促进认知障碍的机制仍有待确定。此外，关于通过抗高血压药物降低血压是否可以预防认知障碍的关键问题尚未得到解答。神经血管生物学、脑成像和流行病学的最新发展以及新的临床试验为这些关键问题提供了见解。特别是，关于神经血管功能障碍和神经变性病理学之间联系的临床和基本发现为血管和阿尔茨海默病病理学之间的重叠提供了新的线索。在这篇综述中，我们将研究高血压与认知障碍之间关系所取得的进展，并在对证据进行严格评估后，尝试找出剩余的知识差距和未来的研究方向，以增进我们对主要健康挑战之一的理解我们这个时代的。