Image Credit: Hush Naidoo / Unsplash. This image has been modified.

High Blood Pressure May Lead to Low Brain Volume

Having hypertension in midlife (ages 40 through 60) is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life, even more so than having the so-called Alzheimer’s gene.

“It is clear that cerebral vascular disease”—that is, hardening of the arteries inside our brain—“and cognitive decline travel hand in hand,” something I’ve addressed before. “However, the independent association of AD [Alzheimer’s disease] with multiple AVD [atherosclerotic vascular disease] risk factors suggests that cholesterol is not the sole culprit in dementia.”

As I discuss in my video Higher Blood Pressure May Lead to Brain Shrinkage, one of the most consistent findings is that elevated levels of blood pressure in midlife, ages 40 through 60, is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life—in fact, even more so than having the so-called Alzheimer’s gene.

“The normal arterial tree”—all the blood vessels in the brain—“is…designed as both a conduit and cushion.” But when the artery walls become stiffened, the pressure from the pulse every time our heart pumps blood up into our brain can damage small vessels in our brain. This can cause “microbleeds” in our brain, which are frequently found in people with high blood pressure, even if they were never diagnosed with a stroke.

These microbleeds may be “one of the important factors that cause cognitive impairments,” “perhaps not surprising[ly],” because on autopsy, “microbleeds may be associated with [brain] tissue necrosis,” meaning brain tissue death.

And speaking of tissue death, high blood pressure is also associated with so-called lacunar infarcts, from the Latin word lacuna, meaning hole. These holes in our brain appear when little arteries get clogged in the brain and result in the death of a little round region of the brain. Up to a quarter of the elderly have these little mini-strokes, and most don’t even know it, so-called silent infarcts. But “no black holes in the brain are benign.” As you can see at 2:12 in my video, it’s as though your brain has been hole-punched.

“Although silent infarcts, by definition, lack clinically overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed.” What’s more, they can double the risk of dementia. That’s one of the ways high blood pressure is linked to dementia.

There’s so much damage that high blood pressure levels can “lead to brain volume reduction,” literally a shrinkage of our brain, “specifically in the hippocampus,” the memory center of the brain. This helps explain how high blood pressure can be involved in the development of Alzheimer’s disease.

As you can see at 3:02 in my video, we can actually visualize the little arteries in the back of our eyes using an ophthalmoscope, providing “a noninvasive window” to study the health of our intracranial arteries, the little vessels inside our head. Researchers “found a significant association” between visualized arterial disease and brain shrinkage on MRI. However, because that was a cross-sectional study, just a snapshot in time, you can’t prove cause and effect. What’s needed is a prospective study, following people over time. And that’s just what the researchers did. Over a ten-year period, those with visual signs of arterial disease were twice as likely to suffer a significant loss of brain tissue volume over time.

What can we do about high blood pressure? A lot! See, for example:

What else can we do to forestall cognitive decline or dementia? I referenced my video Alzheimer’s and Atherosclerosis of the Brain earlier, and here are other videos that offer information on treatment and prevention:


In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

56 responses to “High Blood Pressure May Lead to Low Brain Volume

Comment Etiquette

On, you'll find a vibrant community of nutrition enthusiasts, health professionals, and many knowledgeable users seeking to discover the healthiest diet to eat for themselves and their families. As always, our goal is to foster conversations that are insightful, engaging, and most of all, helpful – from the nutrition beginners to the experts in our community.

To do this we need your help, so here are some basic guidelines to get you started.

The Short List

To help maintain and foster a welcoming atmosphere in our comments, please refrain from rude comments, name-calling, and responding to posts that break the rules (see our full Community Guidelines for more details). We will remove any posts in violation of our rules when we see it, which will, unfortunately, include any nicer comments that may have been made in response.

Be respectful and help out our staff and volunteer health supporters by actively not replying to comments that are breaking the rules. Instead, please flag or report them by submitting a ticket to our help desk. is made up of an incredible staff and many dedicated volunteers that work hard to ensure that the comments section runs smoothly and we spend a great deal of time reading comments from our community members.

Have a correction or suggestion for video or blog? Please contact us to let us know. Submitting a correction this way will result in a quicker fix than commenting on a thread with a suggestion or correction.

View the Full Community Guidelines

  1. How high is high blood pressure ?
    Nobody is the same and amazingly the lowered the number for high blood pressure from 140 to 130 ?
    Now they can pump you earlier with pills.

    Advice for the doktors, tell people to go to plant based food and therefore in most cases no more pills needed.

    Only take the Red pill and you see in what a fake world we live in.

    You are a plant eater to start with, Doktors tell you what they have learned end get only scary enough , 7 hours of nutrition in their career to become a Doktor .

    Your blood pressure most likely drop if you put the right fuel in your biochemical factory .
    Everybody knows not to put Diesel in a Gas car .

    Awareness is what people need, and use your own brain the creator has given you .

  2. Finally the truth about brain shrinkage.

    We do not need plant-based omega 3 to prevent brain shrinkage, like some vegan doctors selling supplements are promoting, but just to regulate our blood pressure to normal level with a whole foods starch-based plant nutrition.

    1. Wait a minute… is it really high blood pressure that triggers brain shrinkage or brain shrinkage that triggers high blood pressure ?

    2. That is clearly not Dr Greger’s position since he recommends a daily 250 mg pollutant-free omega supplement

      After considering the evidence, he concludes that vegans (by which I presume he means everyone who eats a completely vegetarian diet) should take DHA to preserve brain health.

      Jack Norris RD of also considers that it is prudent to take 200-300 mg of DHA daily (or consume 2000 mg of ALA per day from foods.)

      As far as I am concerned, obtaining the recommended amount of ALA from foods is impractical since most of the recommended high ALA foods are either unavailable or unaffordable on a daily basis where I live. There is one that is, canola oil, but I don’t use manufactured fats likes oils, butters etc

      Consequently, in my case at least, using a supplement is the only practical and reliable means of meeting the nutrient requirements for good brain health.

      Simply stating ‘We do not need plant-based omega 3 to prevent brain shrinkage’ is an ideological position not a scientifically-founded one.

        1. Neither chia seeds nor flax seeds are regularly available in my local supermarkets or other stores. In addition, they are very expensive on the rare occasions that they are (I live in the Philippines). Note too that that is 2,000 mg ALA in addition to obtaining the DRI of 1,600 mg of omega 3s daily.

          You might also want to review Dr Greger’s videos on DHA to see why he recommends it for brain health and doesn’t consider large amounts of ALA are always sufficient. One relevant concern is that as we get older, our ability to convert ALA to DHA/EPA decline. WSee this blog post here

          I don’t think that there is conclusive evidence that dietary ALA is sufficient to maintain brain health in ageing ‘vegans’, which is why I described statements that it is as ‘ideological’ rather than science-based. If ab or anyone else, can prove me wrong, that would be wonderful since it would save me a fortune in supplements even if I have to reconsider my stance on (canola) oil.

      1. Dr Greger is wrong on many things including omega 3 based algae supplement which he recommends based on an insignificant studies based on a group of old women with unhealthy diet and potentially smoking.

        Chuck Norris is not a reference as far as health is concerned.

        For more information on why we do not need omega 3 oil supplement on a healthy starch-based plant diet, see the following exposé from Dr Tim Radak

        in which he clearly shows that we can have all the necessary omega 3 from a moderately diverse diet without chia seeds, flax seeds, algae oils or fortified foods:

        1. That said, if Michael Greger MD and Jack Norris RD are concerned about vegans, there are great news: as ideologies shrink the brain, to just stop being a vegan can prevent brain shrinkage and thus perhaps also high blood pressure.

          1. Gee, Dr Greger has to go through the laborious process of finding, analysing and synthesising a whole host of relevant scientific publications before publishing his conclusions here.

            You are clearly far more brilliant than he since all you need to do is state that ‘Dr Greger is wrong on many things’ without providing any supporting evidence. That sort of thing is for mere plodders like Dr G. Superior individuals needn’t bother with such timewasting nonsense. They just know things and, after all, you’ve watched a couple of videos on YouTube. Game, set and match to you I think.

            1. I’m not comparing myself with anyone, I’m talking about precise facts and not about persons.

              Yes, before posting any evidence here, I go through careful watching and cross-checking of facts, unlike some claims that are being made by Dr Greger and repeated by you.

  3. Should I be concerned by suddenly elevated blood pressure at age 68 after a lifetime of being 110/70? It is somewhat managed by medication, but I have been WFPB since February of 2016, and I don’t understand what happened. I get very little help from my pcp in these days of COVID since it isn’t considered high priority at my age.

    1. I have a similar experience. Been WFPB for 10+ years and at 75 I started having high blood pressure. We thought it was migraine related and/or nerve damage issues which has been causing more pain. Started on an rx a few months ago but have been able to drop the dosage to 1/3 to 1/4 of original dosage. I have started using garlic powder. I do everything suggested to lower blood pressure naturally but developed it anyway. The only thing I have not been able to get a handle on is sleeping for more than 4 hrs straight before jangling nerves wake me. I do go back to sleep but don’t stay asleep. Diet and lifestyle doesn’t fix everything.

      1. If you have been taking medications for pain/migraine etc, they could be the cause of raised blood presure. According to the UK’s National Health Service

        Medicines that can increase your blood pressure include:

        the contraceptive pill
        non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and naproxen
        some pharmacy cough and cold remedies
        some herbal remedies – particularly those containing liquorice
        some recreational drugs – such as cocaine and amphetamines
        some selective serotonin-noradrenaline reuptake inhibitor (SSNRI) antidepressants – such as venlafaxine
        In these cases, your blood pressure may return to normal once you stop taking the medicine or drug.

    2. I am not aware of any strong evidence about what I am going to say, but I remember some years ago a lady who had been taking ginger in significant amounts, developed high bp and if you are using ginger quite often, it might be worth to consider. Hope this helps.

    3. Barbie, your are not too old to include a fasting regimen into your annual diet.

      Fasting is the best way to correct high blood pressure, accompanied with a healthy diet.

      Water fasting is very tough for the organism, so I rather recommend an hypocaloric diet for several days (5-7 days), based on vegetables brothes, light soups and small quantities of fruit or vegetable juices, plus water ad libidum. It is not recommended to take medications while fasting so please consult your physician for possible medication contraindication in order to adjust or temporary stop the medications if you have ones.

      An example of hypocaloric diet for one week can be composed of 800 calories for the first day (fruits rice or potatoes) and then 200-400 calories for the other days with vegetable brothes or fruit juice or vegetable juices three times a day. The refeeding should be made gradually on three days with steamed fruit and light soups for example the first day of refeeding.

    4. As a nurse while I agree some of the comments you’ve received may be helpful, I’d also encourage you to keep records of your BP readings then work with your PCP scheduling a time to review. Bring in all the possiblities you can consider (meds, certain foods) to rule these out and show your doctor you are serious in exploring causes. I hope you can get some answers. I assume your exercise level hasn’t changed during this challenging time and stress isn’t severely elevated?

  4. I have a love hate, towards articles like this. I have “the” problem, as clearly articulated in the article. – Burdened with constant massively high BP – Strict vegan for almost 13 years. The article presents the “problem” very well – but, that is all it does.

    It is too late for me, almost 72, the last TIA two weeks ago, damaged my short term memory, not sure I will recover that, one TIA, caused slurred speech, I practised my speaking day & night, until I recovered my ability to enunciate clearly, I have no idea how to “practice” remembering things. Maybe this one too will resolve.

    I have tried “drugs” – ace inhibitors, actually increased my BP after one month – calcium channel blockers caused severe peyronie’s – but, no doctor is going to believe that. ( – I do not take drugs now.

    I take flax every day and drink hibiscus tea, Most days now are a low 150-160/90-100 in that range

    I have conflicting symptoms – eg., nocturnal penile tumescence is a frequent bedfellow – it should not be associated with high BP – it is a real occurrence, not inserted here for effect – please accept that.

    My father died of “strokes” he had his first in his late thirties and made it through to 76. His last ten or so years, were of diminished quality, due to impaired cognitive function. Perhaps it is genetic?

    Thank you for reading.

    1. Mal,

      There are sites people with brain problems use to help develop things like memory.

      If your TIA just happened two weeks ago, you are still in a brain plasticity window and anything you try can help.

      Bob Denis who makes my PEMF has a major stroke and started practicing anything he could think of and regained his speech and his ability to walk and his balance became stronger than before. He ended up becoming ambidextrous and beat young people on brain tests.

      It took time but these weeks are when you want to try as hard as possible.

      There are stem cells that appear in the first month after strokes and they only stay if you keep forcing your brain to learn.

      There are TED talks on it.

      If you don’t have a stent, devices like PEMF or Low Level Laser therapy or TMS or ultrasound are often used to increase brain plasticity.

      As far as TIA’s go, Dr Greger did a vegans and stroke webinar that is available on the Dr Greger website.

    2. Mal,

      Don’t give up.

      I have brain problems but they have improved and part of it is that I watched all of the brain plasticity videos I could find.

      I do things like an ICES PEMF and infrared with my WFPB.

      Go to PUBMED or look at TED Talks on YouTube

      Eventually, I am going to get a vie light gamma. I have decided that right now.

      Maybe next stimulus check if there really is one.

      I just read an interesting article on the microglia causing me to be interested again.

      1. In Hong Kong, they did a study of stroke patients where they used electric foot massagers and the ones who used them were more likely to regain walking.

        Acupuncture would be another thing that can increase neuroplasticity.

        Basically, you want to stimulate the nerves to the brain and that helps generate new neuronal pathways.

        There is a documentary on YouTube called The Brain That Changes Itself.

        You basically want to increase the oxygen to the brain, for sure.

        1. Also learn how to lower glutamate.

          If you have a stroke, preventing a glutamate storm is important.

          Because of my brain problems I decided to learn about brain plasticity and I went to PubMed about glutamate storms and learned what time of day things like strokes happen and little things like drinking a glass of water a few hours before those time periods.

          But Dr Greger did Vitamin D, Omega 3, B-12 and low sodium and other topics in his webinar.

          1. Brain plasticity is a good new topic for you to learn to help your brain get exercise.

            I chose brain plasticity, nutrition, science and I am learning a lot about pandemics.

            Thank you, Dr Greger.

      1. Laughing.


        I see your answers and know that my answers are what it looks like when someone has serious brain damage and tries to do plasticity.

        I still don’t know how to simplify.

        I can say that, in the stroke webinar, the answer for why the Japanese were having strokes was sodium.

        The people of Finland were having them because of saturated fats.

        Dr Greger had mentioned homocysteine and the Omega 3 ratio, but those were old and his webinar was an update in some of those topics.

        Laughing and tearing up at the same time.

        Yes, I still have 5% brain function in a few areas of my brain, but nobody can say that I am not trying.

        1. Deb

          I see your posts and I see posts by a number – sometimes a sizable number – of others here. It’s quite obvious that your posts are rational, informed and employ logic to assess issues whereas theirs do not.

          Yes, you might be guilty of employing a stream-of-consciousness literary technique but then so did James Joyce and Virginia Woolf. Exercising your brain on these topics (or others for that matter) can only he helpful. Keep on doing what you are doing is my advice.

          1. I do agree, Deb provides a great deal of useful information, though the consequent number of posts is sometimes disturbing. I plaid guilty to do the same at times.

              1. There is no guilt to have, I think, we are all here trying to make sense of informations that are presented by doctors. And by discussing, we can see where those information make sense and where it does not make sense. Doctors have their own limitations, so we have to be careful.

  5. Does Dr Greger mean for treated (lowered through drugs to normal healthy numbers) high blood pressure as well as untreated high blood pressure?

    1. He is too focused on his agenda. I have PAH. Nothing he says is connected to me. I am on my 3rd week of a lectin free diet. I lost 10lbs per week.

    2. Mary

      I believe he does since there is evidence that lowering blood pressure through medications benefits brain health. For example, this recent study which indicates a reduction in the risk of cognitive decline and dementia from BP medications

      That said, drugs always have side effects and lowering BP through lifestyle and diet changes is preferable. Note that the major hypertension guidelines always recommend a healthy diet and lifestyle as the preferred treatment (‘non-pharmalogical therapy’) ….. supplemented by drugs in higher risk patients or patients who are unwilling to make those changes.

  6. Thanks for your response Mr F.
    I suppose I assumed everyone here is on a diet of plants! And fungi.
    Blood pressure is better than when eating dairy and eggs, but not altogether normal without some medication.

    Often with these studies, I wonder if they include treated, therefore normalized pressure as normal or are they still including us in the hypertension group.

    1. Mary

      It depends on the individual study. Some studies do exclude people on hypertension drugs but others don’t.

      Also, I suspect it takes time for the full effects of a whole food plant based diet to take effect. It takes decades on a poor diet for the clinical effects to appear after all. They are not likely to disappear completely overnight.

      Some people adopt ‘non-pharmacological therapy’ at the same time as taking drugs and find that as time goes on, their doctor can reduce the drugs’ dosage and eventually discontinue them altogether.

      I also posted these links below a few moments ago further up the thread. I don’t know if you have seen them. They may be relevant

      1. Thanks Tom,

        I have been keeping up with Dr G’s hypertension vlogs. Very helpful. I wish these studies were clear in differentiating between untreated or treated hypertension. And Dr G as well.

        The diet of plants has shifted the meds down to the lowest possible dose, so fingers crossed.


  7. I believe that treated BP is not same as naturally lowering BP and regaining the blood vessel plasticity (This is assuming that the hardened blood vessels can regain plasticity with right diet) . In fact, I think any BP lowering drugs only help to lower blood pressure and sometimes might result in lower blood supply to some regions which are supplied with clogged blood vessels. Hence, best strategy might be initiate the lifestyle and diet changes while starting on the blood pressure medication.
    I also have a personal observation I would like to share. Sometimes, I have found that BP shoots up for no apparent reason (i.e not due to a bad diet or missed bp dose or lack of exercise) but on further analysis, I could relate to digestion /mild stomach infection related issues. In those situations, even doubling the BP medication seemed to have no effect but it eventually resolves when the digestive health is restored/normal gut flora is restored.

  8. In the report “High Blood Pressure May Lead to Low Brain Volume” nothing addresses the data for individuals with ‘controlled’ hypertension. Is there any way to see the results for this extremely common segment of our aging population? Thank you. Dr. Hamlin

  9. Three weeks on a whole food, plant based diet and my BP has gone from 140-145/80 to 117/66! On a lower dose med and working to get off altogether. My weight has dropped from 213 to 197 all without even trying. Just eating right! Yay!
    Past diets were about seeing how much I could eat and still lose weight. Ha! I don’t consider a whole food, plant based diet a diet, but a choice. Yay!

  10. Is this risk for anyone with HBP at all or limited to those with untreated HBP? The article doesn’t make that distinction clear.

    If treatment helps, do certain drugs work better than others?

    1. Generally when health conditions are associated with high blood pressure it is when the blood pressure is untreated. If it is treated and under control the damage is not continuing. The question of what blood pressure mediation could be a whole book and this site focuses on nutritional approaches. Here is an article that discussed BP meds. course some work effectively at cutting down blood pressure, but may also have significant side efects.

  11. Re your blog concerning high blood pressure affecting low blood volume in the brain leading to dementia.
    I notice in these articles there is never a mention of people that have high blood pressure, but are able to keep it under control with medication. is the danger the same, or is it alleviated by being able to keep it under control.

  12. The evidence I’ve seen is that even controlled hypertensives are at increased risk for dementia later in life, but the study stated it may be a problem with statistical power. My take is: eat unprocessed plants, mostly fruit (which have no sodium) and get plenty of exercise. This keeps my BP at around 125/75 without meds. When I start eating salty foods, my BP goes up to 170/100 and I obviously need meds to control it, but I like to avoid this situation.

Leave a Reply

Your email address will not be published. Required fields are marked *

Pin It on Pinterest

Share This