Abstract
The role of the antihypertensive therapy in preventing cognitive disorders in elderly persons without a history of stroke is a matter of debate. This review focuses on the pathogenesis of the cognitive disorders in elderly hypertensives and on the risk factors of their occurrence. Relevant papers were identified by searches in PubMed from 1946 until October 2007, using the key words 'vascular risk factors', 'vascular cognitive impairment', 'vascular dementia', 'neuroimaging in hypertension' and 'antihypertensive treatment'. Blood pressure lowering in elderly patients with long-standing hypertension below a certain critical level may increase the risk of cerebral hypoperfusion and cognitive decline, particularly in cases with additional vascular risk factors. Cerebral white matter lesions have been found in the majority of elderly hypertensives. They have been shown to correlate with cognitive disorders. Appropriate neuropsychological assessment and follow-up of the cognitive functions could be considered with the aim to individualize the antihypertensive therapy and slow down cognitive decline. Prospective studies are needed to confirm such a treatment strategy.
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