High blood pressure damages brain earlier than previously thought

Even young patients should react to the first signs of high blood pressure with lifestyle changes and medication if necessary.

Untreated high blood pressure causes considerable damage to the nerve connections of the brain.

Even young patients should react to the first signs of high blood pressure with lifestyle changes and - if these are not successful - consult with their doctors about taking blood pressure-lowering medication. In many cases, arterial hypertension damages the organs long before patients become aware of their condition.

The damaged organs include the brain. According to a recent US study1, the negative effects of blood pressure levels that have been elevated since adolescence can be seen in impaired gait and reduced cognitive performance such as forgetfulness. Against this background, experts from the German Society for Internal Medicine (Deutsche Gesellschaft für Innere Medizin, DGIM) and the German Hypertension League (Deutsche Hochdruckliga, DHL) point out that young adults should also measure their blood pressure regularly themselves or at least have it checked by their general practitioners or pharmacists.

Vascular damage caused by high blood pressure affects not only the body's organs and vessels, but also brain functions. US scientists studied participants in a long-term epidemiological study. The CARDIA study (Coronary Artery Risk Development in Young Adults) investigates the development of risk factors for coronary heart disease in young adults. More than 5,000 participants between the ages of 18 and 30 were enrolled in this study between 1985 and 1986 and followed up for 30 years. In the course of the observation period, clinical examinations were carried out several times, during which, among other things, systolic and diastolic blood pressure values were determined. This is because high blood pressure is considered a risk factor for coronary heart disease. The researchers also tested the cognitive abilities such as memory or attention of 191 participants and measured their walking speed, step length and gait variability. 144 study participants also had an MRI scan of their brain.

The researchers found that patients whose blood pressure levels had been elevated over the entire observation period - i.e. since they were young - performed worse in cognitive abilities. They also showed slower walking speed, shorter stride length and higher gait variability in the gait analysis. The authors of the study attribute this to damage to certain vascular structures of the brain, white matter lesions. These were particularly evident in the MRI scans of the patients with a noticeable impairment in walking. "This study shows that high blood pressure that starts in early adulthood and remains untreated for years results in considerable damage to the brain's nerve connections," says Professor Dr. Sebastian M. Schellong, Chairman of the DGIM 2020/2021 from Dresden.

Take warning signs of high blood pressure seriously

Against this background, the vascular physician points out that arterial hypertension is the most common internal disease, especially in sporty younger people. Therefore, it is particularly important that young people also take the warning signs of high blood pressure seriously, says Schellong. These warning signs include sleep disturbances, headaches or dizziness. "If the blood pressure is severely elevated, this can manifest itself in symptoms such as shortness of breath under physical exertion, sudden pain in the upper body or severe palpitations," says the head physician of the II. Medical Clinic at the Dresden Municipal Hospital (II. Medizinische Klinik am Städtischen Klinikum Dresden). It is important that young people in particular take these symptoms seriously, says the expert. "Although high blood pressure is a widespread disease in Germany, it too often remains undetected or untreated," says Schellong.

Arterial hypertension often only shows clear effects at an advanced age, mainly after the age of 50, for example in the form of heart failure, coronary heart disease, strokes or kidney insufficiencies. In order to avoid such diseases as far as possible, those affected should clarify the causes of high blood pressure with a doctor at an early stage, advises Professor Dr. med. Oliver Vonend, nephrologist and hypertensiologist from Wiesbaden. As an active member of the board of the German Hypertension League, the prevention of cardiovascular diseases associated with high blood pressure is very close to his heart. First of all, it is important to clarify the causes at an early stage and to exclude diseases of the thyroid gland as a cause. "The first approach to lowering blood pressure is to change one's lifestyle. Stress, smoking and obesity should be reduced and attention should be paid to a healthy diet with a maximum of six grams of salt per day," says Vonend. If these measures do not lead to the desired success, drug therapy is appropriate.

1. Mahinrad S et al. Cumulative Blood Pressure Exposure During Young Adulthood and Mobility and Cognitive Function in Midlife. Circulation 2020; 141: 712-724