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Diet and exercise: blood pressure and cognition: to protect and serve.

Overweight and hypertension are major risk factors for cardiovascular morbidity and mortality1,2; both are associated with decline in cognitive performance.3,4 We know that exercise is associated with modest reductions in blood pressure (BP) and that weight loss results in even larger, clinically important reductions in BP.5 What we did not know, before a report6 in this issue of Hypertension , is whether reductions in BP in association with diet and exercise (or diet alone) are associated with improvement in cognitive functioning. With publication of this article, we have evidence supporting an association of diet and exercise and diet alone with a concordant decline in BP and improvement in cognition.6 These are important findings given a recent meta-analysis of clinical trials of antihypertensive medications that indicated no improvements in cognitive performance associated with decline in BP.7 Two important issues are raised in this editorial comment: are the Smith et al6 findings important clinically, and where should this line of research go from here?

Using a sample of 124 overweight and prehypertensive or moderately (stage 1) hypertensive adults, Smith et al6 examined the association between 2 interventions and a control on cognitive performance for 3 groups: (1) diet alone (Dietary Approaches to Stop Hypertension [DASH]-alone [A]), n=38; (2) diet and exercise (DASH+weight management [WM]), n=43; and (3) usual care control (UC), n=43. The UC group maintained their usual lifestyles.

After 4 months of treatment, participants randomly assigned to the DASH-A group improved with respect to psychomotor speed as compared with persons …