The brain and hypertension. Hypertension-mediated vascular brain damage and its effects on cognitive and behavioral health

Abstract

The brain is the organ most affected by hypertension, and hypertension is the main potentially modifiable vascular risk factor for developing cognitive impairment, Alzheimer's disease, and other dementias. Vascular damage to the brain remains silent for at least a decade, and its clinical expression depends on the hypertensive patient's response to antihypertensive treatment, the control of associated risk factors, and cognitive reserve. Therefore, early cognitive assessment of hypertensive patients—as a (surrogate) biomarker of hypertension-mediated vascular brain damage—improves overall vascular risk stratification and helps prevent cognitive decline. This document provides a practical, evidence-based algorithm and simple tools, such as the clock drawing test, that can be used in clinical practice to detect early brain involvement as a target organ of hypertension.