Low blood pressure shows strongest link to Alzheimer's disease

Numerous types of cardiovascular disease and CVD risk factors were linked to a higher risk of Alzheimer's disease, with low blood pressure showing the strongest connection, according to a new analysis published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

"By examining different types of heart disease individually, we identified which adults with heart disease might have the highest risk for cognitive decline. This highlights the importance of optimal cardiovascular health to possibly prevent Alzheimer's disease," said Aili Toyli, B.S., lead author of the study and a student at Michigan Technological University in Houghton, Michigan.

Cardiovascular disease is a group of conditions that affect the heart and blood vessels throughout the body including the brain, such as coronary heart disease, stroke, heart failure, irregular heartbeat (atrial fibrillation) and risk factors, such as high or low blood pressure and Type 2 diabetes. Alzheimer's disease is the most common type of dementia, which slowly impairs memory, thinking and cognitive function. When there is inadequate blood flow to the brain, the reduced oxygen and nutrients create an environment that can foster accumulation of Alzheimer's-related proteins in the brain, such as amyloid beta and tau.

The study's findings indicate that many heart and blood vessel conditions - particularly those affecting blood flow - are strongly linked to brain health and Alzheimer's disease. While high blood pressure, Type 2 diabetes, obesity and smoking are independent risk factors for both cardiovascular disease and Alzheimer's disease, risk factors, particularly conditions like hypertension, can cause damage to blood vessels (vascular disease) and can lead to cognitive decline.

This study provides new details by analyzing health records for nearly 800,000 adults from 2 databases in the U.K. and the U.S. Specifically, types of heart and blood vessel conditions were individually examined rather than looking at them as a whole group, and then various subgroups were evaluated against the participants diagnosed with Alzheimer's disease at a single point in time over the study period.

What are the key findings of the analysis?

• Adults with hypotension (low blood pressure) in the UK Biobank were about three times more likely to develop Alzheimer's and nearly twice as likely in the All of Us study when compared to individuals who did not have low blood pressure.
• Across both datasets, adults with high blood pressure (hypertension) were 1.6 times more likely to have Alzheimer's disease, compared to people without hypertension.
• Participants who had a previous stroke had a 1.5 times higher risk for Alzheimer's disease in the UK Biobank and 1.85 times in All of Us.
• Among participants in the UK Biobank study, those with irregular heartbeat (or atrial fibrillation, also called AFib) were about 1.5 times more likely to have Alzheimer's disease compared to those without AFib.
• Heart attacks were an exception; they were not significantly linked to an increased risk of developing Alzheimer's disease in either dataset.
• The associations between CVD and Alzheimer's disease appeared to be stronger (three times more likely) among Black and Hispanic participants compared to white participants, especially for high blood pressure.

"Compared to hypertension, hypotension receives a lot less attention overall, which likely leads to less data and less research focus. Detailed research is needed to understand the biological mechanisms that might be behind the links between Alzheimer's and CVD. Once we determine the specific pathway that connects them, we may be able to intervene and break the chain before Alzheimer's develops," said Toyli.

We've known for a long time that high blood pressure can have damaging long-term effects on the brain." 

Elisabeth Marsh, M.D., FAHA, chair of the American Heart Association's 2026 Scientific Statement Brain Health Across the Lifespan

"This study shows us that blood pressure can also become a problem when it is too low for long periods of time. The brain needs blood to get the oxygen and nutrients it needs to function properly. While science is beginning to understand the mechanisms that lead to neurodegeneration and cognitive decline as people age, it's not surprising that low blood pressure leads to dysfunction in the brain because the brain is not getting what it needs."

Marsh, who was not involved in this research, is a professor of neurology and associate director of the neurology residency program at The Johns Hopkins University School of Medicine and director of the Stroke Center at Johns Hopkins Bayview Medical Center in Baltimore.

To help achieve optimal heart health and reduce risk of cardiovascular diseases, the Associations' Life's Essential 8 metrics measure ideal heart and brain health based on an individual's physical activity, diet, smoking status, sleep habits, body mass index, blood pressure, cholesterol and blood sugar.

What are the study details, background and design?

• The study examined information from two large datasets: the UK Biobank, with more than 502,000 adults mostly of European descent, and the All of Us Research Program, with more than 287,000 adults from across U.S.
• In the UK Biobank, participants' average age was about 57 years old; nearly 46% were men, and 54% women; and 94% of participants were self-reported as white.
• In the All of Us study, participants' average age was about 58 years old; 38% were men, and 60% were women; nearly 53% of participants self-reported as white adults, about 20% were Black participants, and nearly 17% were Hispanic participants.
• Researchers examined the links between Alzheimer's disease and 10 types of CVD and CVD risk factors: high blood pressure, low blood pressure, chest pain, heart attack, pulmonary embolism, irregular heartbeat, heart failure, chronic rheumatic heart disease, chronic ischemic heart disease and stroke. Then, lifestyle and other health factors, including age, smoking, physical activity and Type 2 diabetes status, were taken into account.
• Data from the UK Biobank was collected at visits starting in 2006 through the time of the study. All of Us data was collected at enrollment for each participant in 2015 through the time of the study.
• Diagnoses for Alzheimer's disease and the subtypes of cardiovascular disease were from participants' electronic health records using standardized medical billing codes in both datasets.
• Because the data analyzed is from a single point in time, researchers cannot determine if CVD or Alzheimer's came first. Other study limitations included that diagnoses were based on medical billing codes, which may have missed people whose conditions went undiagnosed or were recorded incorrectly. In addition, many participants had more than one cardiovascular condition, making it difficult to measure the possible impact of each one separately.