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Treating Hypertension to Prevent Cognitive Decline and Dementia: Re-Opening the Debate

  • M. Florencia Iulita
  • Hélène GirouardEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 956)

Abstract

Hypertension and dementia are two of the most prevalent and damaging diseases associated with aging. Chronic hypertension, particularly during mid-life, is a strong risk factor for late-life cognitive decline and impairment. Hypertension is also the number one risk factor for stroke and a major contributor to the pathogenesis of vascular dementia and Alzheimer’s disease. Despite the vast epidemiologic and mechanistic evidence linking hypertension to cognitive impairment, and the positive effects of blood pressure lowering on reducing the risk of post-stroke dementia, uncertainty remains about the benefit of antihypertensive medication on other forms of dementia. This chapter reviews the link between hypertension and cognition, and discusses the evidence for and against the use of antihypertensive medication for dementia prevention.

Keywords

Hypertension Cognitive dysfunction Dementia Stroke Antihypertensive drugs Vascular risk factors 

Abbreviations

ABPM

ambulatory blood pressure monitoring

ACEI

angiotensin-converting enzyme inhibitor

AD

Alzheimer’s disease

AngII

angiotensin II

ARB

angiotensin-II receptor blocker

ASCOT

Anglo-Scandinavian Cardiac Outcomes Trial

amyloid-β

BBB

blood-brain barrier

BP

blood pressure

CCB

calcium channel blocker

CI

confidence interval

DBP

diastolic blood pressure

DHP

dihydropyridine

DSM-IV

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition

FDG-PET

Fludeoxyglucose (18F)-Positron Emission Tomography

FINGER

Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability

HCTZ

hydrochlorothiazide

HOPE

Heart Outcomes Prevention Evaluation

HR

hazard ratio

HYVET

Hypertension in the Very Elderly Trial

ICD-10

International Classification of Diseases 10th Revision

JNC-8

Eighth Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

MCI

mild cognitive impairment

MMSE

mini mental state examination

MRC

Medical Research Council

MRI

magnetic resonance imaging

PiB-PET

Pittsburgh compound B-Positron Emission Tomography

PP

pulse pressure

PROGRESS

Perindopril Protection Against Recurrent Stroke Study

RRR

relative risk reduction

SBP

systolic blood pressure

SCOPE

Study on Cognition and Prognosis in the Elderly

SHEP

Systolic Hypertension in the Elderly

SPRINT

Systolic Blood Pressure Intervention Trial

SYST-EUR

Systolic Hypertension in Europe

VaD

vascular dementia

Notes

Acknowledgements

MFI would like to acknowledge support from the Herbert H. Jasper Postdoctoral Research Fellowship in Neurosciences from the Groupe de Recherche sur le Système Nerveux Central (GRSNC), Université de Montréal, and from a Bourse Postdoctorale from the Fonds de recherche du Québec – Santé (FRQS). HG would like to acknowledge support from the Heart and Stroke Foundation of Canada, the Canadian Institutes of Health Research and the Canadian Foundation for Innovation. HG is the holder of an investigator award from the FRQS.

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© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Neurosciences, Faculty of MedicineUniversité de MontréalMontréalCanada
  2. 2.Department of Pharmacology, Faculty of MedicineUniversité de MontréalMontréalCanada

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