Fig. 6.

Mechanism by which hypertension affects cognitive function.

Note: Hypertension can cause direct damage to vascular endothelium and decrease cerebral perfusion. Hypertension-related alteration in cerebral autoregulatory mechanisms and neurovascular coupling can cause changes in vascular tone and reduce cerebral perfusion. Alternatively, direct hypertension-related damage to the endothelium may alter endothelia nitric oxide function with resultant change in vascular tone and cerebral hypoperfusion. Concomitant or hypertension-related changes in angiotensin receptor and or angiotensin converting enzyme can directly promote amyloid deposition as well as alter cerebral perfusion through changes in vascular tone. Below age-specific optimal blood pressure can directly reduce cerebral perfusion and promote chronic cerebral oxygen insufficiency, a common pathway by which hypertension-related β-amyloid pathology, peri-nueronal inflammation and consequent cognitive loss occurs.