Recent developments and challenges in hypertensive dementia over the past year

The Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (JSH2025) were published last year. Additionally, the Prevention of Cognitive Impairment by Hypertension Management (PCIHM) working group of the Japanese Society of Hypertension's Academic Committee released a statement summarizing the latest basic research and clinical and epidemiological findings on "hypertensive dementia". Numerous research papers on hypertension-related dementia were published over the past year, and evidence is accumulating. Reports indicate that blood pressure variability, rather than absolute blood pressure levels, is gaining attention as a factor inducing dementia; furthermore, blood pressure targets are being set lower, and even strict blood pressure control in the elderly does not lead to cognitive decline. On the other hand, it goes without saying that we must avoid a one-size-fits-all approach for the elderly; instead, we must determine blood pressure targets on an individual basis, for example, by avoiding excessive blood pressure reduction in elderly patients who already have cerebral small-vessel disease. As a "beyond guidelines" initiative, we here summarize reports related to "hypertensive dementia" published since the guidelines were released and explore the trends. Recent reports on "hypertensive dementia" are on the rise. The number of PubMed articles found by searching for "high blood pressure" and "dementia" reached nearly 800 last year and has already exceeded 220 this year (as of the end of March). While the JSH2025 guidelines were published in August 2025, I would like to review some of the interesting basic and clinical research papers published over the past year or so, consider recent trends and future developments regarding hypertension and dementia.