Elevated blood pressure linked to lower dementia risk in people with physical frailty

For people with physical frailty, having high blood pressure may be associated with a lower risk of dementia, according to a study published on June 10, 2026, in Neurology^®, the medical journal of the American Academy of Neurology. The study did not find a lower risk of dementia in people with high blood pressure who were more robust. High blood pressure was associated with a higher risk of dementia in people with no signs of frailty.

The study does not prove that having high blood pressure and frailty causes a lower risk of dementia; it only shows an association.

Physical frailty is defined as having three or more of these five symptoms: often feeling tired; little or no physical activity; slow walking speed; low grip strength; and unintentional weight loss. Researchers defined pre-frailty as having one or two of the symptoms. For the study, people with pre-frailty and frailty were compared to people with none of the symptoms, who were defined as robust.

Because low blood pressure has been associated with worse outcomes in frail people, we want to see how blood pressure related to the risk of dementia in people with frailty. While high blood pressure is still a concern for the majority of people, we may need to look at people's overall health and whether they are showing signs of frailty as we consider how to manage their blood pressure."

Jason R. Smith, PhD, study author, University of North Carolina in Chapel Hill

For the study, researchers looked at data from 6,135 people with an average age of 75 who were followed for a median of nine years. At the start of the study, 334 people met the criteria for frailty, 2,376 for pre-frailty and 2,383 for being robust.

During the study, 30% of those with frailty or pre-frailty developed dementia, compared to 16% of those who were robust. Among the participants with pre-frailty or frailty, those with elevated blood pressure and those with hypertension developed dementia at a rate of 29.5 and 41.2 cases, respectively, per 1,000 person-years, compared to 42.3 cases per 1,000 person years for those with normal blood pressure. Person-years represent both the number of people in the study and the amount of time each person spent in the study. For the robust participants, those with elevated blood pressure and hypertension developed dementia at a rate of 13.3 and 20.2 cases, respectively, compared to 12.6 for those with normal blood pressure.

When researchers adjusted for other factors that could affect the risk of dementia, such as age, smoking status and diabetes, they found that people with signs of frailty and elevated blood pressure were 32% less likely to develop dementia than those with normal blood pressure. The robust participants with high blood pressure were 39% more likely to develop dementia than those with normal blood pressure.

"It's exciting to think that even for people in their 80s, we could help preserve people's brain health by choosing their optimal blood pressure target based on whether they have signs of frailty," Smith said. "More research is needed to determine whether managing blood pressure in this way could truly lower the risk of dementia."

A limitation of the study is that researchers did not account for the age when participants first had symptoms of vascular conditions and how well those conditions were controlled with treatment.

The study was supported by the National Institutes of Health and the Sense Network.