Blood Pressure and Brain Health: A Hidden Connection You Need to Know About

Blood Pressure and Brain Health: A Hidden Connection You Need to Know About

Bet you didn’t know that these two were intimately linked. Here’s how managing one through exercise significantly improves the other.

By Richard Isaacson, MDUpdated April 5, 2022


At your annual checkup, the nurse wraps the cuff around your upper arm, squeezes the rubber bulb, watches the dial on the gauge for a few moments, then jots down some numbers. Those numbers represent your blood pressure and, chances are, you know they have something to do with your heart health.

But not many people realize that blood pressure is also intimately linked with brain health—so much so that maintaining optimal blood pressure throughout your 20s, 30s, 40s and beyond can drastically reduce your chances of one day developing dementia.

This is exciting news if you’re someone who spends time biking, running, strength training, practicing yoga or otherwise moving your body in a way that gets your heart pumping on most days of the week. That’s because when it comes to managing blood pressure, exercise is key.

What Is High Blood Pressure?

Your blood pressure reading—those two numbers the nurse wrote down at the start of your physical—is a reflection of the force with which your blood pushes against the insides of the walls of your blood vessels. (It’s literally your blood’s pressure.) The first number, called systolic blood pressure, measures the pressure in your arteries as your heart muscle beats, while the second number, your diastolic blood pressure, measures that pressure as your heart rests between beats.

When your blood pressure is at a healthy level, every organ in your body benefits, receiving all the oxygen- and nutrient-rich blood it needs. Your heart is strong and doesn’t need to work any harder than necessary to pump all day long.

But about half of the U.S. population has high blood pressure, also called hypertension. It can affect anyone, but your risk increases if you...

  • Don’t get enough physical activity

  • Are overweight

  • Eat way too much salt

  • Drink too much alcohol or smoke

  • Are stressed out

  • Skimp on sleep

Research shows people with depression, diabetes, kidney disease or who are African American or middle-aged and older also face a higher risk.

Over time, high blood pressure causes your arteries to toughen up and thicken, sort of like a callous on your foot that forms from months of running. That, in turn, forces the heart to pump harder and harder to circulate blood throughout your body. Cholesterol also begins to stick to the inside of the arteries, increasing your risk of a heart attack or stroke, not to mention kidney issues, vision loss, erectile dysfunction, and low sex drive in women (every part of your body needs oxygen-rich blood to thrive).

Your Brain and High Blood Pressure

Elevated blood pressure can also damage tiny blood vessels by prompting small strokes in the brain, and that is as unwanted as it sounds for memory and comprehension. Early on, you won’t notice the impact of these tiny strokes on your thinking, but the damage can and does build. The outcome could lead to vascular cognitive impairment, or vascular dementia, which happens when poor blood flow to the brain damages and, ultimately, kills brain cells. It can occur suddenly, as in the case of stroke caused by a complete blood vessel blockage or brain bleed, but it also happens more insidiously, transpiring mildly over time.

Imagine a smartphone that starts to slow down over time, losing processing speed, taking longer to connect to the internet and draining its battery power more quickly than it used to. This is essentially what’s happening to your brain thanks to high blood pressure.

The Study That Changed Everything

For decades, the medical community thought that ~140/80 mmHG was a normal, healthy blood pressure. But a few years ago, results from a large study called the SPRINT MIND trial forced everyone to take a second look. This research was designed, in part, to see if lowering blood pressure would affect the future risk of dementia or mild cognitive impairment (MCI), an early stage of memory loss, or changes in thinking that may be precursors to dementia.

Researchers found that people who were able to reduce their blood pressure from the 140s/80s to the 120s/70s or below were able to slash their risk of MCI by 19 percent in three years. That’s an impressive reduction and could mean the difference between living out your retirement in vibrant cognitive health or struggling with memory loss. The growing body of evidence combined with these findings was so compelling that multiple medical organizations eventually changed their guidelines: The American Heart Association, Centers for Disease Control and Prevention and American College of Cardiology all now consider less than 120/80 mmHG to be a healthy blood pressure. Anything higher and you’ve got hypertension.

Exercise: Your Brain’s Secret Weapon

Results from the SPRINT MIND trial may be the strongest evidence we’ve encountered that it is possible to delay or maybe even prevent the onset of the earliest symptomatic stages of dementia. This is incredibly encouraging to me, not just as a neurologist and the director of the newly launched Florida Atlantic University Center for Brain Health within the Schmidt College of Medicine, but as someone who has lost multiple family members to Alzheimer’s disease (AD). And as an avid exerciser (in fact, I’m typing this post while riding with Leanne Hainsby right now!), it’s especially exciting because I have one of the keys to healthy blood pressure management right at my fingertips. Even though the SPRINT MIND trial participants were taking a variety of blood pressure medications, I believe that exercise is just as powerful, if not more so.

Working out is one of the best things you can do to maintain healthy blood pressure. The heart is a muscle, and it grows stronger with regular exercise, just as your other muscles do. The stronger your heart, the more blood it can pump with less effort and the lower your blood pressure. Even a single exercise session has the power to reduce blood pressure for up to 24 hours. Frequent workouts also help maintain a healthy body weight, and because being overweight or obese is a hypertension risk factor, exercise plays strongly in your favor.

In addition, exercise has anti-inflammatory effects that protect blood vessels and arteries. A recent study published in Brain, Behavior, and Immunity found that 20 minutes of daily moderate-intensity treadmill work decreased damaging inflammation.

How Much Exercise (and What Type) Do You Need?

That’s the magic question. There’s no one-size-fits-all answer because you need to take your fitness level, body fat, genetics, biological sex and more into account, including your doctor’s sign-off on your workout regime. But generally speaking, five (or even six) days of exercise a week is an excellent overall goal. For my patients, I usually recommend three of those workouts consist of cardiovascular work: cycling, running, dance cardio, brisk walking—anything that gets your heart rate up. The other two should focus on strength training to build muscle and boost metabolism.

When it comes to cardio, mix up your intensity and session length. High-intensity interval training (HIIT) is wildly popular among Peloton Members and for good reason: Alternating harder bursts of exercise (pushing so hard that you get breathless) with periods of recovery is great for strengthening the heart and lowering blood pressure. The harder you push, the greater the blood pressure effect, but be mindful of your limits.

You should also incorporate lower intensity, steady-state cardio, by which I mean workouts that remain at a lesser pace for a longer time. Shoot for 45 to 60 minutes of your preferred aerobic activity, keeping your heart rate to 60-65 percent of your max. During this effort, you should be able to carry on a conversation.

Nearly 6 million Americans currently have AD, but nearly 50 million more have the early rumblings of dementia lurking in their brain. Physical fitness is a golden ticket to keeping your brain healthy for as long as possible (combined, of course, with good nutrition, quality sleep, stress reduction and other cognitive-enhancing measures).

Richard S. Isaacson, MD is a neurologist and clinician-researcher who specializes in Alzheimer’s disease (AD) prevention and treatment; he is also a paid consultant member of the Peloton Health & Wellness Advisory Council. Dr. Isaacson is currently the director of the newly launched Florida Atlantic University Center for Brain Health and Alzheimer’s Prevention Clinic within the Schmidt College of Medicine. He is committed to using technology and lifestyle interventions, such as physical exercise and nutrition, to optimize patient care, AD risk assessment and early intervention. For more on what you can do to support brain health, check out Dr. Isaacson’s free online video course.

This content is for informational and educational purposes only and does not constitute individualized advice. It is not intended to replace professional medical evaluation, diagnosis, or treatment. Seek the advice of your physician for questions you may have regarding your health or a medical condition. If you are having a medical emergency, call your physician or 911 immediately.