Hypertension and the Brain: Vulnerability of the Prefrontal Regions and Executive Functions

Untreated hypertension negatively affects brain anatomy and cognitive functions, but the effects of medically treated hypertension are unclear. The authors compared 40 middle-age and older adults diagnosed with essential hypertension to demographically matched normotensive peers. Volumes of 7 brain regions and deep and periventricular white-matter hyperintensities (WMH) were measured on magnetic resonance imaging scans. Performance in 4 cognitive domains (perseveration, working memory, fluid reasoning, and vocabulary knowledge) was evaluated. Persons with hypertension had smaller prefrontal cortex and underlying white matter volumes and increased frontal WMH. No group differences were found in other examined brain regions. Among examined cognitive variables, hypertensive patients committed significantly more perseverative errors. Thus, even controlled hypertension may be associated with deficits in brain structure and cognition, warranting further study.