Blood pressure and dementia: A review

Citation
G. Abate et al., Blood pressure and dementia: A review, ARCH GER G, 2001, pp. 7-18
Citations number
70
Categorie Soggetti
Medical Research General Topics
Journal title
ARCHIVES OF GERONTOLOGY AND GERIATRICS
ISSN journal
01674943 → ACNP
Year of publication
2001
Supplement
7
Pages
7 - 18
Database
ISI
SICI code
0167-4943(2001):<7:BPADAR>2.0.ZU;2-E
Abstract
Hypertension is a well known risk factor for cerebrovascular events and, th erefore, for vascular dementia, but the relationships of hypertension with senile dementia of Alzheimer's type (SDAT) are still debated. In cross-sect ional studies, patients with cognitive impairment due to SDAT show blood pr essure values lower than in normal controls or in subjects with other forms of dementia; this finding is explained by the atrophy of brain structures involved in central blood pressure regulation. However, longitudinal observ ations, revealed that high blood pressure values are independently related to the onset of SDAT, suggesting that hypertension may contribute to the de velopment of degenerative dementias. Indeed, magnetic resonance imaging stu dies have shown, in old hypertensive subjects, atrophy of brain structures, which seems more evident when blood pressure is poorly controlled. Moreove r, pathological studies show that, in patients with hypertension, the brain is characterized by higher density of senile plaques. An increased product ion or deposition of beta-amyloid substance and impairments in regional blo od flow and/or in protective autoregulatory mechanisms, particularly signif icant in watershed areas of arterial supply, could explain the link between hypertension and SDAT. Recent therapeutical studies are in agreement with the above findings, showing that treatment with different classes of antihy pertensive drugs may reduce the risk of incident dementia. New trials, spec ifically designed to assess the effects of therapy on cognition in elderly hypertensives, now in progress, will provide new insight on this issue, whi ch represents a huge socioeconomic problem in industrialized countries.