Epidemiological and clinical evidence on blood pressure management for the prevention of dementia: striving for a healthy 100-year life

As Japan faces rapid population aging, understanding modifiable risk factors for dementia is critical. This review explores the impact of hypertension and blood pressure (BP) management on dementia onset. Midlife hypertension emerges as a key risk factor, especially for vascular dementia, while late-life BP effects are variable. Observational studies suggest a critical window for intervention between ages 55–74. Moreover, BP variability independently predicts cognitive decline. Though randomized controlled trials show mixed outcomes, meta-analyses suggest that intensive BP lowering may reduce dementia risk, particularly in settings where BP reductions are substantial. These results suggest that systolic BP of <130 mmHg is desirable and support lower and stable BP control from early age as a public health strategy to delay the onset of dementia. The Japanese Society of Hypertension emphasizes three fundamental principles of BP management—early initiation, lower BP in midlife, and stable control—for preventing dementia/cognitive impairment.