Abstract
Hypertension (HT) and dementia are common disorders in the elderly. HT in the elderly is associated with increased occurrence rates of dementia including Alzheimer's disease (AD) and vascular dementia (VaD). In connection to this, some studies have suggested that HT in old age correlates with the pathogenesis of dementia. Since HT is potentially reversible, a number of randomized trials have examined whether antihypertensive treatment may help in preventing dementia occurrence. We review five studies, all using subjects 60 years or older, which investigated different antihypertensive pharmacological treatments. Data from two trials (Syst-Eur, PROGRESS) open the way toward the prevention of dementia (AD or VaD) by antihypertensive treatments. In the Syst-Eur study, with the dihydropyridine calcium antagonists, a reduction in both types of dementia was demonstrated (risk reduction 55%). The PROGRESS study showed that the use of angiotensin-converting enzyme inhibitors (ACEIs), with or without diuretics, resulted in decrease incidence of stroke-related dementia (risk reduction 19%), but dementia without stroke was not reduced. In contrast, the SHEP trial, treatment with a chlorthalidone-based antihypertensive regimen, did not significantly reduced the incidence of dementia. The SCOPE study (candesartan or hydrochlorothiazide versus placebo) and the HYVET-COG study (indapamide or perindopril versus placebo) found no significant difference between the active treatment and placebo group on the incidence of dementia. We found conflicting results regarding treatment benefits in dementia prevention. Recent clinical trials and studies on animal models suggest that blockades of RAS system could have reduced cognitive decline seen in Alzheimer's disease and vascular dementia. Future trials primarily designed to investigate the effects of antihypertensive agents on impaired cognition are needed.
Highlights
The risk of HT, which is defined as a systolic blood pressure (SBP) ≥140 mm Hg and/or a diastolic blood pressure (DBP) ≥90 mm Hg [1], increases with advancing age
Considering that the incidence of dementia among the elderly population is rising rapidly worldwide [10] and accumulating evidence that HT may contribute to the development of both Alzheimer’s disease (AD) and vascular dementia (VaD) [11], there is a reason to believe effective management of HT may International Journal of Hypertension translate into major health benefits through the protection of dementia
It is thought that there is a dependent relationship between the occurrence of HT and the risk of developing dementia in old age
Summary
The risk of HT, which is defined as a systolic blood pressure (SBP) ≥140 mm Hg and/or a diastolic blood pressure (DBP) ≥90 mm Hg [1], increases with advancing age. In Framingham study, 90% of all 65-year-old men and women with normal BP later developed HT [2] This condition carries a very high risk for cerebrovascular disease (CVD) as well as coronary heart disease (CHD) [3]. It has been observed that long-standing HT may lead to severe atherosclerosis and impaired cerebrovascular autoregulation, which in turn is thought to correlate with dementia [4]. For these reasons, several studies have investigated whether antihypertensive treatment may retard cognitive decline or dementia [5,6,7,8,9]. The importance of lowering BP in HT subjects is well known, the relationship between HT and cognitive function is controversial
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