A review of hypertension and vascular cognitive impairment

Vascular cognitive impairment (VCI) is a cognitive dysfunction syndrome caused by various vascular-related risk factors, with hypertension regarded as one of the main pathogenic factors. Chronic hypertension can promote cognitive decline through abnormal microcirculation structure, white matter fiber injury, blood–brain barrier destruction, oxidative stress, and neuroinflammatory reaction, increasing the incidence of vascular dementia. To fully grasp the research status in this field, this study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for literature identification. A controlled vocabulary-based search strategy was employed to screen PubMed, Embase, Web of Science, and Cochrane Library for human studies published from January 2000 to March 2025, focusing on hypertension, VCI, dementia, antihypertensive treatment, and aerobic exercise intervention. Analysis of literature shows that angiotensin converting enzyme inhibitors and calcium channel blockers may play a neuroprotective role by increasing cerebral blood flow, reducing oxidative stress, and delaying amyloid deposition. However, these mechanisms and their clinical results are still controversial. Aerobic exercise, particularly moderate and high-intensity exercise, can continuously improve cerebral blood flow, promote neuroplasticity development, and enhance cognitive performance. However, significant limitations remain in the existing research. Thus, it is essential to conduct a systematic, integrated analysis and further strengthen standardized experimental design and personalization.