Hypertension affects two-thirds of people aged >60 years and significantly increases the risk of both vascular cognitive impairment and Alzheimer’s disease. Hypertension compromises the structural and functional integrity of the cerebral microcirculation, promoting microvascular rarefaction, cerebromicrovascular endothelial dysfunction and neurovascular uncoupling, which impair cerebral blood supply. In addition, hypertension disrupts the blood–brain barrier, promoting neuroinflammation and exacerbation of amyloid pathologies. Ageing is characterized by multifaceted homeostatic dysfunction and impaired cellular stress resilience, which exacerbate the deleterious cerebromicrovascular effects of hypertension. Neuroradiological markers of hypertension-induced cerebral small vessel disease include white matter hyperintensities, lacunar infarcts and microhaemorrhages, all of which are associated with cognitive decline. Use of pharmaceutical and lifestyle interventions that reduce blood pressure, in combination with treatments that promote microvascular health, have the potential to prevent or delay the pathogenesis of vascular cognitive impairment and Alzheimer’s disease in patients with hypertension.

高血压影响三分之二 >60 岁的人，并显着增加血管性认知障碍和阿尔茨海默病的风险。高血压会损害脑微循环的结构和功能完整性，促进微血管稀疏、脑微血管内皮功能障碍和神经血管解偶联，从而损害脑供血。此外，高血压会破坏血脑屏障，促进神经炎症和淀粉样蛋白病理的恶化。衰老的特点是多方面的稳态功能障碍和细胞应激恢复能力受损，这加剧了高血压对脑微血管的有害影响。高血压引起的脑小血管疾病的神经放射学标志物包括白质高信号、腔隙性梗塞和微出血，所有这些都与认知能力下降有关。使用降低血压的药物和生活方式干预措施，结合促进微血管健康的治疗，有可能预防或延缓高血压患者血管性认知障碍和阿尔茨海默病的发病机制。