Low blood pressure linked to highest Alzheimer's risk among cardiovascular conditions, study finds

Numerous types of cardiovascular disease (CVD) 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.

The study analyzed health records for nearly 800,000 adults from two databases: 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 the U.S. Researchers examined the links between Alzheimer's disease and 10 types of CVD and CVD risk factors, including 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.

Across both datasets, adults with low blood pressure (hypotension) 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. 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 (atrial fibrillation) 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 among Black and Hispanic participants compared to white participants, especially for high blood pressure, with about three times higher risk.

“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.

Elisabeth Marsh, M.D., FAHA, chair of the American Heart Association’s 2026 Scientific Statement Brain Health Across the Lifespan, who was not involved in this research, commented: “We’ve known for a long time that high blood pressure can have damaging long-term effects on the brain. 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.”

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. The American Heart Association’s Life’s Essential 8 metrics measure ideal heart and brain health based on physical activity, diet, smoking status, sleep habits, body mass index, blood pressure, cholesterol and blood sugar.

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.