Arterial stiffness measured by pulse wave velocity correlated with cognitive decline in hypertensive individuals: A systematic review

Abstract Background Arterial stiffness is a degenerative modification of the arterial wall significantly influencing normal aging, longevity, and vascular health. Hypertension is a major risk factor for the development of arterial stiffness, which can lead to changes in cerebral perfusion and cognitive dysfunction. This, in turn, can increase the risk of cognitive decline. Pulse wave velocity (PWV) is an established gold standard for measuring arterial stiffness. Studies have shown that individuals with hypertension and elevated PWV are more likely to experience worse cognitive decline compared to those with either condition alone. The current literature, however, demonstrates controversial results. The aim of this article is to review the most recent published studies linking arterial stiffness to cognitive function in individuals with arterial hypertension. Methods We conducted a systematic review following the Cochrane protocol that was registered through the NIHR PROSPERO system. The PRISMA 2020 guidelines were used for reporting the systematic review. PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched for relevant publications from early June to the end of December 2022. This review includes publications with a sample size of at least 500 participants older than 45 years. Screening of abstracts and full-text review of chosen articles were carried out through the Covidence. Results A total of 434 articles were selected for the full-text review. Twenty-four longitudinal studies and four cross-sectional designs that met the inclusion criteria were selected for the comparisons. The total sample size for these studies was 56,946 individuals. Twenty-seven studies (95%) demonstrated a significant association between arterial stiffness and cognitive dysfunction in hypertensive individuals. One study reported an association between stiffness and cognition independent of blood pressure (5% of the total population). Conclusion The results of this systematic review showed that arterial hypertension is one of the most important factors linking arterial stiffness to cognitive disorders. Pulse wave velocity was shown to be a strong measure associated with cognitive decline in aging individuals with chronically elevated blood pressure. Early screening for arterial stiffness, hypertension treatment, and effective prevention of cerebrovascular disease are imperative for cognitive health. NIHR PROSPERO registry ID: CRD 42022379887