Blood Vessel Health
High blood pressure, high cholesterol, and diabetes can all impact your brain health.
⏱ 4 min read
Blood vessel health
Because damage to the blood vessels in the brain can cause dementia or strokes, it’s very important to maintain good blood vessel health. You can do this by monitoring and controlling blood pressure, cholesterol levels, and diabetes. Managing these factors can decrease your risk of developing dementia, having heart attacks or strokes, and may play a key role in protecting brain health.
High blood pressure (hypertension)
High blood pressure or hypertension can be associated with strokes and increased risk of vascular dementia. Managing high blood pressure can reduce your risk of dementia. High blood pressure is generally defined as a blood pressure over 120/80 mm Hg. You may hear your health care provider refer to ‘systolic’ or ‘diastolic’ blood pressure; these refer to the top and bottom numbers of your blood pressure. The top number is called the ‘systolic’ blood pressure, and the bottom number is called the ‘diastolic’ blood pressure.
Blood pressure targets
For most people, the top number (systolic) should be less than 140 and the bottom number (diastolic) should be less than 90. However, for some people with diabetes, the target might be less than 130/80 mm Hg. For others who might be at higher risk of heart disease, or for some older adults or those who are frail, the targets might be different.
According to the Lancet Commission report on dementia prevention, the evidence around dementia risk reduction says you should aim to maintain a systolic blood pressure (top number) of 130 mm Hg or less in midlife from around 40 years old.
Talk to your doctor about the best blood pressure target for you in order to balance the benefits of managing your blood vessel health, while ensuring that you are not running into adverse effects of your blood pressure getting too low.
Managing high blood pressure
There are non-medication things that you can do to help manage high blood pressure, including some of the other lifestyle factors that we’ve mentioned above, such as:
- Diet
- Exercise
- Reducing alcohol consumption, as well as
- Stress reduction
Medications – known as anti-hypertensives – are often needed if non-drug approaches can’t bring the blood pressure to a reasonable target. Sometimes people might need more than one class of anti-hypertensive drug. At this time, anti-hypertensive drug treatment for hypertension is the only known effective preventive medication for dementia. (Although there is some new research on medications for diabetes that is also showing promise.)
You can learn more about high blood pressure, choosing a blood pressure monitor, and tracking your blood pressure on the Hypertension Canada website.
Diabetes and hemoglobin A1C test
Diabetes can impact your blood vessels, and increase your risk of blood vessel damage and dementia. Conversely, good management of your diabetes can help to reduce your risk of dementia.
A hemoglobin A1C (HbA1C) test is a blood test that shows what your average blood sugar (glucose) level was over the past two to three months. Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:
- A normal A1C level is below 5.7%
- Prediabetes is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year.
- Type 2 diabetes is above 6.5%
- If you have diabetes, you should have the A1C test at least twice a year.
The A1C goal for many people with diabetes is below 7%. For older adults with multiple medical conditions the goal is to keep the A1C less than 8%.
It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.
It’s important to balance the benefits of maintaining a good A1C level with the risks of low blood sugars or the side effects of multiple medications.
Managing diabetes
There are non-medication things that you can do to help manage diabetes, including some of the same lifestyle factors that we’ve mentioned above, such as diet and exercise.
Many people may also require medications to manage their diabetes if non-drug approaches can’t bring the blood sugars or HbA1C to manageable levels.
You can learn more about diabetes on the Diabetes Canada website.
High cholesterol (dyslipidemia)
There is less evidence with respect to the role that high cholesterol (also known as dyslipidemia) might play in dementia. Currently, the recommendations are more related to heart health, rather than brain health.
Diet, exercise, and weight management are non-medication approaches to high cholesterol. If those are not effective in lowering your cholesterol, then there may be a role for cholesterol-lowering drugs like statins or others.
Unlike anti-hypertensives, there is currently no evidence that statin medications reduce the risk of dementia on their own.
Key points from this topic
- Check your blood pressure and manage high blood pressure
- Ask your doctor if you should be assessed for diabetes
- If you have diabetes, there are non-medication and medication approaches to achieve a healthy HbA1C
- Assess your cholesterol and reduce high cholesterol for your heart health.
The good news is that if you’re eating right and exercising, you’ve taken the first steps to maintain blood vessel health. If, after eating right and exercising, these factors are still not well controlled, you may need to work with your doctor and use medications as prescribed.
Talk to your health care team about checking your blood pressure, and whether you should be evaluated to check your cholesterol and blood sugar. Many pharmacies also have programs to help with high blood pressure and diabetes; check with your local pharmacist to see if they offer services for these conditions.
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Authors
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Anthony J. Levinson, MD, MSc, FRCPC
Neuropsychiatrist, Professor; Faculty of Health Sciences, McMaster University
About this Project
Who authored and edited this page?
This page was developed by the Division of e-Learning Innovation team and Dr. Anthony J. Levinson, MD, FRCPC (Psychiatry). Dr. Levinson is a psychiatrist and professor in the Department of Psychiatry and Behaviour Neurosciences, Faculty of Health Sciences, McMaster University. He is the Director of the Division of e-Learning Innovation, as well as the John Evans Chair in Health Sciences Educational Research at McMaster. He practices Consultation-Liaison Psychiatry, with a special focus on dementia and neuropsychiatry. He is also the co-developer of the iGeriCare.ca dementia care partner resource, and one of the co-leads for the McMaster Optimal Aging Portal. He and his team are passionate about developing high-quality digital content to improve people's understanding about health. By the way, no computer-generated content was used on this page. Specifically, a real human (me) wrote and edited this page without the help of generative AI like ChatGPT or Bing's new AI or otherwise.
Are there any important disclosures or conflicts of interest?
Dr. Levinson receives funding from McMaster University as part of his research chair. He has also received several grants for his work from not-for-profit granting agencies. He has no conflicts of interest with respect to the pharmaceutical industry; and there were no funds from industry used in the development of this website.
When was it last reviewed?
August 22, 2023
What references and evidence were used to create this content?
Content was written and adapted based on credible, high-quality, non-biased sources such as MedlinePlus, the National Institutes for Mental Health, the McMaster Optimal Aging Portal, the American Psychiatric Association, the Cochrane Library, the Centre for Addictions and Mental Health (CAMH) and others. In particular, evidence-based content about dementia risk reduction was also derived from the World Health Organization and the Lancet Commission reports. Please see additional references on the e-learning lesson landing page.
Who funded it?
The initial development of some of this content was funded by the Centre for Aging and Brain Health Innovation, powered by Baycrest. Subsequent funding was through support from the McMaster Optimal Aging Portal, with support from the Labarge Optimal Aging Initiative, the Faculty of Health Sciences, and the McMaster Institute for Research on Aging (MIRA) at McMaster University, and the Public Health Agency of Canada. There are no conflicts of interest to declare. There was no industry funding for this content.
