The role of treatment of arterial hypertension, inflammatory and metabolic disorders in the struggle for active longevity

This review summarizes current evidence on the role of arterial hypertension, chronic inflammation, and metabolic disorders in vascular and cognitive aging and their relevance to active longevity. The major pathophysiological mechanisms of age-related vascular damage are discussed, including endothelial dysfunction, increased arterial stiffness, chronic low-grade inflammation (inflammaging), metabolic inflammation (metaflammation), impaired cerebral perfusion, and neurovascular dysfunction. Current approaches to the management of modifiable risk factors and the potential role of antihypertensive, cardio- and angioprotective, and metabolic therapies are analyzed. Particular attention is given to the relationship between arterial hypertension and cognitive impairment. Randomized trial evidence suggests that intensive blood pressure control may reduce the risk of mild cognitive impairment, whereas its effect on dementia prevention remains less certain and requires further investigation. The importance of individualized therapeutic targets in older adults is emphasized, taking into account cognitive and functional status, renal function, and frailty. Overall, the available evidence supports comprehensive cardiovascular and metabolic risk management as a key strategy for preventing premature vascular and cognitive aging and preserving functional independence.