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The association between blood pressure and cognitive function

Published online by Cambridge University Press:  17 February 2011

Michiya Igase ,
Katsuhiko Kohara  and
Tetsuro Miki
Michiya Igase*
Affiliation:
Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Japan
Katsuhiko Kohara
Affiliation:
Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Japan
Tetsuro Miki
Affiliation:
Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Japan Proteo-Medicine Research Center, Ehime University, Japan
*
Address for correspondence: Michiya Igase, Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime 791–0295, Japan. Email: migase@m.ehime-u.ac.jp
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Summary

Longer lifespans have been accompanied by an increasing number of older people suffering from impaired cognitive function (dementia) including Alzheimer's disease (AD) and vascular dementia (VaD). Some studies have suggested that hypertension in old age correlates with the pathogenesis of dementia. Since hypertension is potentially reversible, a number of randomized trials have examined whether antihypertensive treatment may help to prevent dementia. We review five studies, all using subjects aged 60 years or older, which investigated different antihypertensive pharmacological treatments and found conflicting results regarding impact on dementia. At the same time, other studies have suggested that hypotension in older people, especially those with low diastolic blood pressure, are also at higher risk for developing dementia. Four studies are reviewed here, but none is able to determine unequivocally if hypotension is a cause or a consequence of dementia in old age.

Keywords

hypertensionhypotensiondementiacognitionantihypertensive treatment
Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 3 , August 2011 , pp. 201 - 208
Copyright
Copyright © Cambridge University Press 2011

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References

1Alzheimer's Association. 2010 Alzheimer's disease facts and figures. Alzheimers Dement 2010; 6: 158–94.CrossRefGoogle Scholar
2Kennelly, SP, Lawlor, BA, Kenny, RA. Blood pressure and the risk for dementia: a double edged sword. Ageing Res Rev 2009; 8: 61–70.Google Scholar
3Forette, F, Seux, ML, Staessen, JA, Thijs, L, Babarskiene, MR, Babeanu, S, Bossini, A, Fagard, R, Gil-Extremera, B, Laks, T, Kobalava, Z, Sarti, C, Tuomilehto, J, Vanhanen, H, Webster, J, Yodfat, Y, Birkenhäger, WH. Systolic Hypertension in Europe Investigators. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002; 162: 2046–52.CrossRefGoogle ScholarPubMed
4Tzourio, C, Anderson, C, Chapman, N, Woodward, M, Neal, B, MacMahon, S, Chalmers, J.PROGRESS Collaborative Group. 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: 1069–75.Google Scholar
5Applegate, WB, Pressel, S, Wittes, J et al. Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Arch Intern Med 1994; 154: 2154160.Google Scholar
6Lithell, H, Hansson, L, Skoog, I, Elmfeldt, D, Hofman, A, Olofsson, B, Trenkwalder, P, Zanchetti, A.SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.CrossRefGoogle Scholar
7Peters, R, Beckett, N, Forette, F, Tuomilehto, J, Clarke, R, Ritchie, C, Waldman, A, Walton, I, Poulter, R, Ma, S, Comsa, M, Burch, L, Fletcher, A, Bulpitt, C.HYVET investigators. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVETCOG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683–89.CrossRefGoogle ScholarPubMed
8Lenfant, C, Chobanian, AV, Jones, DW, Roccella, EJ.Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Hypertension 2003; 41: 1178–79.CrossRefGoogle ScholarPubMed
9Chen, JH, Lin, KP, Chen, YC. Risk factors for dementia. J Formos Med Assoc 2009; 108: 754–64.Google Scholar
10Gorelick, PB. Risk factors for vascular dementia and Alzheimer disease. Stroke 2004; 35: 2620.CrossRefGoogle ScholarPubMed
11McGuinness, B, Todd, S, Passmore, P, Bullock, R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev 2009; 2: CD004034.Google Scholar
12Guo, Z, Viitanen, M, Fratiglioni, L, Winblad, B. Low blood pressure and dementia in elderly people: the Kungsholmen project. BMJ 1996; 312: 805–8.Google Scholar
13Morris, MC, Scherr, PA, Hebert, LE, Bennett, DA, Wilson, RS, Glynn, RJ, Evans, DA. The cross-sectional association between blood pressure and Alzheimer's disease in a biracial community population of older persons. J Gerontol A Biol Sci Med Sci 2000; 55: M130–36.Google Scholar
14Verghese, J, Lipton, RB, Hall, CB, Kuslansky, G, Katz, MJ. Low blood pressure and the risk of dementia in very old individuals. Neurology 2003; 61: 1667–72.CrossRefGoogle ScholarPubMed
15Molander, L, Gustafson, Y, Lövheim, H. Low blood pressure is associated with cognitive impairment in very old people. Dement Geriatr Cogn Disord 2010; 29: 335–41.Google Scholar
16Sonnesyn, H, Nilsen, DW, Rongve, A, Nore, S, Ballard, C, Tysnes, OB, Aarsland, D. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord 2009; 28: 307–13.Google Scholar
17Mehrabian, S, Duron, E, Labouree, F, Rollot, F, Bune, A, Traykov, L, Hanon, O. Relationship between orthostatic hypotension and cognitive impairment in the elderly. J Neurol Sci 2010; 299: 45–48.CrossRefGoogle ScholarPubMed
18Tzourio, C, Anderson, C, Chapman, N, Woodward, M, Neal, B, MacMahon, S, Chalmers, J. PROGRESS Collaborative Group. 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: 1069–75.Google Scholar
19Blood Pressure Lowering Treatment Trialists’ Collaboration, Turnbull, F, Neal, B, Pfeffer, M, Kostis, J, Algert, C, Woodward, M, Chalmers, J, Zanchetti, A, MacMahon, S. Blood pressure-dependent and independent effects of agents that inhibit the renin–angiotensin–system. J Hypertens 2007; 25: 951–58.Google Scholar
20Krikov, M, Thoene-Reineke, C, Müller, S, Villringer, A, Unger, T. Candesartan but not ramipril pre-treatment improves outcome after stroke and stimulates neurotrophin BNF/TrkB system in rats. J Hypertens 2008; 26: 544–52.Google Scholar
21Fournier, A, Messerli, F, Achard, J, Fernandez, L.Cerebroprotection mediated by angiotensin II: a hypothesis supported by recent randomized clinical trials. J Am Coll Cardiol 2004; 43: 1343–47.Google Scholar
22Boutitie, F, Oprisiu, R, Achard, JM, Mazouz, H, Wang, J, Messerli, FH, Gueyffier, F, Fournier, A. Does a change in angiotensin II formation caused by antihypertensive drugs affect the risk of stroke? J Hypertens 2007; 25: 1543–53.Google Scholar
23The ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk of vascular events. N Engl J Med 2008; 358: 1547–59.Google Scholar
24The Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial. Lancet 2008; 372: 1174–83.Google Scholar
25Diener, HC, Sacco, RL, Yusuf, S, Cotton, D, Ounpuu, S, Lawton, WA, Palesch, Y, Martin, RH, Albers, GW, Bath, P, Bornstein, N, Chan, BP, Chen, ST, Cunha, L, Dahlöf, B, De Keyser, J, Donnan, GA, Estol, C, Gorelick, P, Gu, V, Hermansson, K, Hilbrich, L, Kaste, M, Lu, C, Machnig, T, Pais, P, Roberts, R, Skvortsova, V, Teal, P, Toni, D, VanderMaelen, C, Voigt, T, Weber, M, Yoon, BW. Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study group. Effects of aspirin plus extended release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol 2008; 7: 875–84.Google Scholar
26Fogari, R, Mugellini, A, Zoppi, A, Lazzari, P, Destro, M, Rinaldi, A, Preti, P. Effect of telmisartan/hydrochlorothiazide vs. lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens 2006; 20: 177–85.Google Scholar
27Tsukuda, K, Mogi, M, Iwanami, J, Min, LJ, Sakata, A, Jing, F, Iwai, M, Horiuchi, M. Cognitive deficit in amyloid-beta-injected mice was improved by pretreatment with a low dose of telmisartan partly because of peroxisome proliferator-activated receptor-gamma activation. Hypertension 2009; 54: 782–87.CrossRefGoogle ScholarPubMed