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Dementia risk across blood pressure categories: a South Korean nationwide study

Young Hee Jung1, Jonguk Kim2, Kyung-Do Han3

  • 1Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gwanpyeong-ro 170 beon-gil 22, Dongan-gu, 14068 Anyang-si, Gyeonggi-do, Republic of Korea.

European Heart Journal
|October 30, 2025
PubMed

Insights

New 2024 European Society of Cardiology (ESC) guidelines define elevated blood pressure (BP). Both elevated BP and hypertension increase dementia risk, particularly vascular dementia (VaD), highlighting the need for early management.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • The 2024 European Society of Cardiology (ESC) guidelines introduced a new category: 'elevated blood pressure' (BP) (systolic 120-139 mmHg or diastolic 70-89 mmHg).
  • This category is positioned between non-elevated BP and hypertension.
  • The impact of this reclassification on dementia risk was previously unclear.

Purpose of the Study:

  • To investigate the association between the new 2024 ESC blood pressure (BP) categories and the risk of developing dementia.
  • To determine if elevated blood pressure, as defined by the 2024 ESC guidelines, is a risk factor for all-cause dementia, Alzheimer's disease dementia, and vascular dementia.

Main Methods:

  • Analysis of a nationwide Korean cohort comprising 2.8 million adults aged 40 years and older, screened in 2009.
  • Exclusion of participants with pre-existing dementia or diagnosed within one year of cohort entry.
  • Classification of blood pressure into non-elevated BP, elevated BP, or hypertension based on 2024 ESC criteria, with dementia incidence tracked until 2018 using Cox proportional hazards models.

Main Results:

  • Over an average follow-up of 8.1 years, 121,223 dementia cases were recorded.
  • Compared to the non-elevated BP group, elevated BP showed a modest increase in dementia risk (aHR 1.016), while hypertension showed a significant increase (aHR 1.029).
  • The association was particularly strong for vascular dementia (VaD) (elevated BP: aHR 1.159; hypertension: aHR 1.372), but not significant for Alzheimer's disease dementia. Associations were more pronounced in midlife adults and women.

Conclusions:

  • The 2024 ESC blood pressure classification indicates that both elevated BP and hypertension are linked to an increased risk of dementia, especially VaD.
  • These findings underscore the clinical significance of the 2024 ESC criteria for identifying individuals at risk.
  • Midlife adults and women may benefit from targeted early blood pressure management strategies to preserve cognitive health.
Abstract

Keywords:
Blood pressureCohort studyDementiaESC guidelinesHypertensionVascular dementia

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