Blood pressure, cholesterol and the brain

Your brain needs a steady supply of blood. When blood vessels are damaged by high blood pressure, high cholesterol or a stroke, brain cells can lose the oxygen they need. Over time, this makes memory and thinking problems more likely.

The good news is that blood pressure and cholesterol are risks you can do something about. This page explains what the research shows, where it is still thin, and what you can do.

Why the heart and the brain are linked

High blood pressure, high cholesterol and diabetes can damage the large and tiny blood vessels that feed the brain.¹⁴ Damage can happen in two ways. A large stroke can block blood to one area and cause sudden changes. Many tiny strokes, or slow damage to small vessels, can build up quietly over years.¹⁴

When this causes dementia, it is called vascular dementia. Only about 5 to 10 in 100 people with dementia have vascular dementia alone. It is much more common as part of mixed dementia, together with Alzheimer's.¹⁴

In 2024, a major expert group called the Lancet Commission listed 14 health and lifestyle factors linked to dementia. Together, they may explain nearly half of all dementia cases worldwide. High blood pressure was already on the list. High LDL cholesterol was added in 2024.¹ This does not mean half of dementia can surely be prevented, but these are good places to start.

High blood pressure: the most studied risk

Nearly half of U.S. adults have high blood pressure. Only about 1 in 4 of them has it under control.⁶ High blood pressure usually causes no symptoms, so many people do not know they have it.¹²

Blood pressure has two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is the pressure between beats. Here is how the American Heart Association groups the numbers:¹⁵

Studies that follow people over many years find a clear pattern. High blood pressure in midlife is linked to more memory and thinking decline later.² The Lancet Commission found that people with untreated high blood pressure had about 42% higher dementia risk than healthy people. With treatment, much of that extra risk went away.¹

What SPRINT MIND found

SPRINT was a large U.S. trial. It included 9,361 adults aged 50 and older with high blood pressure. People with diabetes or a past stroke were not included. Their average age was about 68, and more than 1 in 4 were 75 or older.³

Half were treated to a top number below 120, and half to the usual goal of below 140. Treatment lasted about three years, with follow-up for about five.³ The brain part of the study is called SPRINT MIND.

Source for the table: SPRINT MIND, JAMA 2019.³

What this means in daily life. The lower goal did not prove it prevents dementia itself. But it did lower the chance of mild cognitive impairment (MCI, memory or thinking problems that are noticeable but do not yet get in the way of daily life). The trial was stopped early because the lower goal also cut heart problems and deaths. That left fewer dementia cases to count, so the study may have been too short to show a dementia effect.³ Brain scans also showed that tighter control slowed the buildup of white matter damage (small areas of injury in the brain's wiring).²

A 2025 trial that did show less dementia

In 2025, a very large trial in rural China tested a simple program. It included 33,995 adults aged 40 and older whose high blood pressure was not under control. Villages were randomly chosen to get the program or usual care.⁴

In program villages, trained health workers adjusted blood pressure medicines, with a doctor overseeing them. The goal was below 130/80. After four years, the top number was about 22 points lower than in usual-care villages. Dementia was about 15% less common, and serious side effects were slightly less common, not more.⁴

This is one of the strongest signs so far that treating high blood pressure can prevent some dementia. It took place in one country, in people whose blood pressure was poorly controlled, so results may differ elsewhere.

What the newest U.S. guideline says

In August 2025, the American Heart Association and the American College of Cardiology released a new high blood pressure guideline. It sets a goal below 130/80 for most adults. For the first time, it names a top number below 130 as a goal to help prevent memory and thinking decline and dementia.⁵ It also urges treating high blood pressure early, and recommends checking blood pressure at home.⁵

The National Institute on Aging calls the evidence on blood pressure and Alzheimer's encouraging but not final. Nothing has yet been proven to prevent Alzheimer's disease.² Still, controlling blood pressure protects your heart and lowers your stroke risk, so it is worth doing for many reasons.

A note for people in their late 70s and older

Some older adults feel dizzy when they stand up on blood pressure medicines, which can lead to falls. Research in people 75 and older is mixed, and the best target differs from person to person.² Your doctor will weigh your other health problems, falls and medicines, and may start low and go slow.

Cholesterol and the brain

LDL cholesterol is often called "bad" cholesterol. It can build up in blood vessel walls. The Lancet Commission found good, consistent evidence that high LDL in midlife raises dementia risk. In one analysis, every 1 mmol/L rise in LDL (about 39 mg/dL on a U.S. lab report) was linked to about 8% more dementia.¹ The Commission advises finding and treating high LDL starting in midlife.¹

Do statins prevent dementia? Statins are common medicines that lower LDL. They clearly help prevent heart attacks and strokes. For dementia, the answer is less clear:

• Studies that watch large groups of people over time often find statin users get dementia less often. But these studies cannot prove the statin caused the difference.¹
• A Cochrane review looked at two large trials with 26,340 people aged 40 to 82. Statins started later in life did not prevent memory decline or dementia.⁸ Limited research
• Experts think the timing may matter. Lowering LDL in midlife may help more than starting late in life.¹

A large NIH-funded trial called PREVENTABLE is now testing whether a statin helps adults aged 75 and older stay free of dementia and disability. It plans to enroll up to 20,000 people.⁹ Results were not yet available as of October 2026.

The CDC advises having cholesterol checked at least every five years.¹² If you take a statin for your heart, keep taking it as prescribed, and bring any worries about side effects to your doctor.

Atrial fibrillation (AFib)

Atrial fibrillation (AFib) is an irregular, often fast heartbeat. The top chambers of the heart quiver instead of beating strongly. Blood can pool and form clots that travel to the brain.¹¹ AFib becomes more common with age. Some people feel a fluttering or pounding heart, tiredness or dizziness. Others feel nothing at all.¹¹

AFib raises the risk of the most common type of stroke about five times. It causes about 1 in 7 strokes, and these strokes tend to be more severe.¹¹ High blood pressure is behind about 1 in 5 cases of AFib.¹¹

AFib is also linked to dementia, even apart from stroke. A 2021 review of 43 studies found that people with AFib were about 1.6 times as likely to develop dementia. The link held for both Alzheimer's and vascular dementia.¹⁰ These studies show a link, not proof of cause, and some results may be skewed.¹⁰

Treatment includes medicines to control the heart's rhythm or rate, and blood thinners to lower the risk of clots and stroke.¹¹ Whether AFib treatment also protects memory is still being studied, but preventing strokes is reason enough to follow your plan.

Preventing stroke protects the brain

A stroke can cause memory and thinking problems right away, or add to damage over time.¹⁴ Many strokes can be prevented. The CDC suggests these steps:¹²

• Get your blood pressure checked regularly, and treat it if it is high.
• Have your cholesterol tested, and treat it if it is high.
• If you have AFib or another heart condition, follow your treatment plan.
• If you have diabetes, keep your blood sugar in your target range. See diabetes, weight and dementia risk.
• Do not smoke. Quitting at any age helps. See sleep, alcohol and smoking.
• Aim for about 2.5 hours a week of moderate activity, such as brisk walking. See exercise for brain health.
• Take your medicines as prescribed.

What you can do

Treating sleep apnea also helps the heart and brain. For a full daily plan, see keeping your brain healthy. Heart disease and stroke can also bring on depression. See depression with heart disease and stroke.

When to talk with your doctor

Make an appointment if:

• You have not had your blood pressure or cholesterol checked recently
• Your home readings are often 130/80 or higher
• You feel dizzy or lightheaded when you stand up, or you have fallen
• You notice a fluttering or racing heartbeat
• You or your family notice new memory or thinking changes. See mild cognitive impairment.

If you care for someone living with dementia, their heart health still matters. Keep their medicines and readings in a memory notebook to bring to visits.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.