It has been identified for the first time worldwide by a Korean research team that the risk of developing vascular dementia increases even at the “elevated blood pressure” stage, which is slightly higher than the normal blood pressure range. This study is highly significant as it is the first large-scale population-based research to demonstrate the clinical risk of the newly introduced elevated blood pressure range, following the 2024 guideline revision by the European Society of Cardiology (ESC) that tightened the diagnostic criteria for hypertension.

The research team consisting of Prof. Min Woo Lee (corresponding author) and Prof. Young Hee Jung of the Department of Neurology at Hallym University Sacred Heart Hospital, Prof. Jong Wook Kim of the Department of Neurology at Seoul National University Bundang Hospital, Prof. Kyung Do Han of the Department of Information Statistics and Actuarial Science at Soongsil University, and Prof. Dae Young Cheon of the Division of Cardiology at Hallym University Dongtan Sacred Heart Hospital announced large-scale study results analyzing the correlation between blood pressure and dementia incidence using data from the National Health Insurance Service (NHIS).

Although it is well known that hypertension is a major risk factor for dementia, there has been no clear evidence on how the “pre-hypertensive” range below the diagnostic threshold for hypertension affects the onset of dementia. Recently, as studies have suggested that even slightly elevated blood pressure can influence the risk of cardiovascular disease, the European Society of Cardiology revised its 2024 guideline to newly define the pre-hypertensive range (systolic 120–139 mmHg or diastolic 70–89 mmHg) as elevated blood pressure and recommended blood pressure management in this group.

The research team used NHIS data to track approximately 2.8 million adults aged 40 years or older, who underwent health checkups in 2009 and 2010, over an average of eight years, and analyzed the association between their blood pressure status and the occurrence of dementia.

The subjects were categorized into three groups according to the 2024 ESC guideline: normal blood pressure (systolic less than 120 mmHg and diastolic less than 70 mmHg), elevated blood pressure (systolic 120–139 mmHg or diastolic 70–89 mmHg), and hypertension (systolic 140 mmHg or higher, diastolic 90 mmHg or higher, or on antihypertensive medication). The risk of dementia incidence was then compared across these three groups.

During the follow-up period, a total of 121,223 dementia cases occurred, of which 76.6% were Alzheimer’s disease and 12.1% were vascular dementia. The analysis showed that, compared with the normal blood pressure group, the risk of dementia increased in both the elevated blood pressure and hypertension groups. In the elevated blood pressure group, the overall risk of dementia increased by 1.6%, while in the hypertension group the overall dementia risk increased significantly by 2.9%.

The risk of vascular dementia, which occurs due to cerebrovascular damage, was particularly notable. Compared with the normal blood pressure group, the elevated blood pressure group had a 16% higher risk and the hypertension group had a 37% higher risk, confirming that the risk of vascular dementia increases stepwise as blood pressure rises.

Age-stratified analysis showed that the risk increase associated with blood pressure was most pronounced among middle-aged adults aged 40–64 years. In this age group, the elevated blood pressure group had an 8.5% higher risk of dementia than the normal blood pressure group, while the hypertension group had a 33.8% higher risk.

Sex-stratified analysis revealed that women experienced a more pronounced increase in dementia risk associated with rising blood pressure than men. Among women, a significant increase in dementia risk was observed in both the elevated blood pressure and hypertension groups, whereas among men, a significant association was found only in the hypertension group.

Prof. Min Woo Lee stated, “This study is significant in that it demonstrates that the new concept of elevated blood pressure proposed by the European Society of Cardiology is highly effective in predicting actual dementia risk, particularly the risk of vascular dementia,” and emphasized, “Active blood pressure management is necessary from the stage where systolic blood pressure exceeds 120 mmHg or diastolic blood pressure exceeds 70 mmHg—namely, even before a hypertension diagnosis—to protect cerebrovascular health.” Prof. Lee added, “In particular, middle-aged adults and women should regard even slightly elevated blood pressure as an early warning sign of dementia and engage in proactive management and prevention, such as correcting lifestyle habits.”

This study was published in a cardiovascular journal under the title “Dementia Risk According to Blood Pressure Categories: A Nationwide Study of the Entire Korean Population.”

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