Abstract
Hypertension and dementia are highly prevalent in the general population. Hypertension has been shown to be a risk factor for Alzheimer's dementia and vascular dementia. Sleep apnea, another common disorder, is strongly associated with hypertension and recent evidence suggests that it may also be linked with cognitive decline and dementia. It is possible that sleep apnea is the final common pathway linking hypertension to the development of dementia. This hypothesis merits further exploration as sleep apnea is readily treatable and such therapy could foreseeably delay or prevent the onset of dementia. At present, there is a paucity of therapeutic modalities that can prevent or arrest cognitive decline. In this review, we describe the associations between hypertension, dementia and sleep apnea, the pathophysiologic mechanisms underlying these associations, and the literature examining the impact of treatment of hypertension and sleep apnea on cognition. Potential areas of future investigation that may help advance our understanding of the magnitude and direction of the interaction between these conditions and the effects of treatment of high blood pressure and sleep apnea on cognition are highlighted.
Highlights
Hypertension has recently been recognized as a risk factor for cognitive decline/dementia [1, 2]
There was no convincing evidence of reduction in risk of cognitive decline in two placebo-controlled randomized controlled trials evaluating the effects of renin-angiotensin system blockade on cognitive function in subjects at high risk of cardiovascular disease [57, 58]
There is evidence that excessive lowering of nocturnal blood pressure (BP) may itself contribute to changes that may predispose to risk of dementia [62, 63]
Summary
Hypertension has recently been recognized as a risk factor for cognitive decline/dementia [1, 2]. Several large epidemiologic studies have demonstrated a link between high BP in midlife (4th−5th decades of life) and cognitive decline or AD in later life, i.e., in the subsequent 20–30 years [19,20,21,22,23] This association has been more consistently established for diastolic BP (DBP) than systolic BP (SBP) [22, 23]. Early-onset hypertension in childhood, adolescence or young adulthood, and duration of high SBP exceeding 25–30 years significantly enhances the risk, as does a combination of elevated BP in midlife coupled with low DBP in late-life [24,25,26] This is especially concerning, given that the prevalence of hypertension in younger individuals has been increasing steadily in the general population [27]. It appears that angiotensin receptor blockers (ARBs) may be superior to other agents in decreasing the risk of cognitive decline/dementia according to a recent meta-analysis; this may be related to the possible neuroprotective effect of ARBs themselves rather than due to a reduction in BP [64]
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