Current Hypertension Reports

, Volume 6, Issue 5, pp 357–362 | Cite as

Hypertension and dementia: Does blood pressure control favorably affect cognition?

  • Elizabeth I. Majeski
  • Colin E. Widener
  • Jan Basile


Dementia and aging are not synonymous. Dementia is a progressive deterioration in cognitive and social and/or occupational functions that can eventually impair a patient’s ability to live independently. Alzheimer’s disease is the most common form of dementia. It accounts for 50% to 70% of all patients with dementia. Vascular dementia, responsible for up to 15% of all diagnosed cases, is the second most common form of dementia. Hypertension remains a significant risk factor for vascular dementia. The optimal level of blood pressure control for the prevention of dementia and whether one particular class of antihypertensive drug is more beneficial than another remains uncertain.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Hebert LE, Scherr PA, Bienias JL, et al.: Alzheimer disease in the US Population: prevalence estimates using the 2000 Census. Arch Neurol 2003, 60:1119–1122.PubMedCrossRefGoogle Scholar
  2. 2.
    Wentzel C, MacKnight C, Hachinski V, et al.: Cerebral white matter lesions and subjective cognitive dysfunction: the Rotterdam scan study. Neurology 2001, 56:1539–1545.Google Scholar
  3. 3.
    Pohjasraara T, Yliloski MA, Kaste M, et al.: Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. Stroke 2000, 31:2952–2957.Google Scholar
  4. 4.
    Strub R: Vascular dementia. South Med J 2003, 96:363–366.PubMedCrossRefGoogle Scholar
  5. 5.
    Hachinski VC, Lassen NA, Marshal J: Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 1974, ii:207–210.CrossRefGoogle Scholar
  6. 6.
    Wolfe N, Babikian VL, Knoefel JE, et al.: Frontal systems impairment following multiple lacunar infarcts. Arch Neurol 1990, 47:129–132.PubMedGoogle Scholar
  7. 7.
    Shumaker SA, Legault C, Thal L, et al.: Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: The Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA 2003, 289:2651–2662.PubMedCrossRefGoogle Scholar
  8. 8.
    Shumaker SA, Legault C, Kuller L, et al.: Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA 2004, 291:2947–2958.PubMedCrossRefGoogle Scholar
  9. 9.
    Etminan M, Gill S, Samii A: Effect of non-steroidal antiinflammatory drugs on risk of Alzheimer’s disease: systematic review and meta-analysis of observational studies (review). BMJ 2003, 327:128.PubMedCrossRefGoogle Scholar
  10. 10.
    Jick H, Zornberg G, Jick S, et al.: Statins and the risk of dementia. Lancet 2000, 256:1627–1631.CrossRefGoogle Scholar
  11. 11.
    Engelhart MJ, Geerlings MI, Ruitenberg A, et al.: Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 2002, 287:3223–3229.PubMedCrossRefGoogle Scholar
  12. 12.
    Morris MC, Evans DA, Bienias JL, et al.: Dietary intake of antioxidants and the risk of incident Alzheimer disease in a biracial community study. JAMA 2002, 287:3230–3237.PubMedCrossRefGoogle Scholar
  13. 13.
    Sano M, Ernesto C, Thomas RG, et al.: A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease: The Alzheimer’s Disease Cooperative Study. N Engl J Med 1997, 336:1216–1222.PubMedCrossRefGoogle Scholar
  14. 14.
    Verghese J, Lipton RB, Katz MJ, et al.: Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003, 348:2508–2516.PubMedCrossRefGoogle Scholar
  15. 15.
    Gorelick P: Stroke prevention. Arch Neurol 1995, 52:347–354.PubMedGoogle Scholar
  16. 16.
    Ross GW, Petrovitch H, Masaki KH, et al.: The relation between mid-life blood pressure and dementia: the Honolulu Aging Study (abstract). Neurology 1998, 50:A229.Google Scholar
  17. 17.
    Launer LJ, Petrovich K, Foley D, et al.: The association between midlife blood pressure levels and late-life cognitive function: The Honolulu-Asia aging study. JAMA 1995, 274:1846–1851.PubMedCrossRefGoogle Scholar
  18. 18.
    Tzourio C, Ducimetiere P, Alperovitch A: Cognitive decline in individuals with high blood pressure. Neurology 1999, 53:1948–1952.PubMedGoogle Scholar
  19. 19.
    Lithell H, Hansson L, Skoog I, et al.: The study on cognition and prognosis in the elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003, 21:875–886. In this study, candesartan was compared with placebo plus additional antihypertensive agents for reduction of cardiovascular events, cognitive decline, and dementia.PubMedCrossRefGoogle Scholar
  20. 20.
    SHEP Cooperative Group: Prevention of stroke by antihypertension drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991, 265:3255–3264. In this study, the effects of an active treatment group (low-dose diuretic and/or β-blocker) and placebo group on isolated systolic hypertension-related fatal/nonfatal stroke, myocardial infarction, fatal coronary disease, major cardiovascular morbidity and mortality, and cognitive decline were evaluated.CrossRefGoogle Scholar
  21. 21.
    Di Bari M, Pahor M, Franse LV, et al.: Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in elderly program (SHEP) trial. Am J Epidemiol 2001, 153:72–78.PubMedCrossRefGoogle Scholar
  22. 22.
    Gurland B, Golden R, Challop J: Unidimensional and multidimensional approaches to the differential of depression and dementia in the elderly. In Alzheimer’s Disease: A Report of Progress in Research. Edited by Corkin S, Davis K, Crowden J. New York: Raven Press; 1981.Google Scholar
  23. 23.
    Weissman MM, Sholomskas D, Pottenger M, et al.: Assessing depression symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1997, 106:203–214.Google Scholar
  24. 24.
    Jette AM, Branch LG: The Framingham Disability Study: II. Physical disability among the aging. Am J Public Health 1981, 71:1211–1216.PubMedGoogle Scholar
  25. 25.
    Berkman LF: The assessment of social networks and social support in the elderly. J Am Geriat Soc 1983, 31:743–749.PubMedGoogle Scholar
  26. 26.
    Brayne C, Gill C, Huppert FA, et al.: Incidence of clinically diagnosed subtypes of dementia in an elderly population: Cambridge Project for Later Life. Br J Psychiatry 1995, 167:255–262.PubMedGoogle Scholar
  27. 27.
    PROGRESS Collaborative Group: Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischemic attack. Lancet 2001, 358:1033–1041.CrossRefGoogle Scholar
  28. 28.
    Tzourio C, Anderson C, Chapman N, et al.: Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003, 163:1069–1075.PubMedCrossRefGoogle Scholar
  29. 29.
    Fagard RH, Staessen JA: Treatment of isolated systolic hypertension in the elderly: the Syst-Eur trial. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Clin Exper Hypertens 1999, 21:491–497. This large scale, randomized trial evaluated participants with a history of previous stroke or TIA to determine the effect of blood pressure-lowering medications on the risks of dementia and cognitive decline.CrossRefGoogle Scholar
  30. 30.
    Forette F, Seux ML, Staessen JA, et al.: The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) Study. Arch Intern Med 2002, 162:2046–2052. Results of this trial showed that therapy with the calcium channel blocker nitrendipine decreased the incidence of dementia by 55%, suggesting that its prevention of dementia might be due to specific neuroprotection.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2004

Authors and Affiliations

  • Elizabeth I. Majeski
    • 1
  • Colin E. Widener
    • 1
  • Jan Basile
    • 1
  1. 1.Primary Care (11C), Ralph H. Johnson VA Medical CenterCharlestonUSA

Personalised recommendations