Pulse pressure and cognitive impairment

Elevated pulse pressure (PP) is the one of simplest and most accessible markers of vascular damage and increased arterial stiffness in hypertension (HTN). To date, an extensive body of evidence has been accumulated in terms of the PP effect on central nervous system (CNS), leading to neuronal damage and death, which contribute to the development and progression of cognitive impairment (CI). Elevated PP violate the blood-brain barrier, can intensify the production of reactive oxygen species in the CNS, lead to endothelial dysfunction, microbleeds and directly stimulate the amyloid beta creation, which is a substrate of Alzheimer’s disease. Due to the important role of increased PP in CI, an important aspect of antihypertensives’ effects is their impact on PP and the ability to reduce it. Among antihypertensives, a single-pill combination of amlodipine/indapamide sustained release deserves special attention, since it has a body of evidence for reducing PP and thereby improving cognitive functioning in patients with HTN, which in turn will improve their quality of life.