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Antihypertensive treatments, cognitive decline, and dementia.
J Alzheimers Dis. 2010; 20(3):903-14.JA

Abstract

Chronic hypertension is associated with an increased risk of both vascular dementia and Alzheimer's disease (AD). In this context, the role of anti-hypertensive therapy for the prevention and delay of cognitive decline and dementia is of central importance. Most longitudinal studies have shown a significant inverse association between anti-hypertensive therapies and dementia incidence and for some of these, particularly in AD. Seven randomized, double blind placebo-controlled trials have evaluated the benefit of antihypertensive treatments on cognition. Three of them found positive results in term of prevention of dementia (SYST-EUR) or cognitive decline (PROGRESS, HOPE). Others disclosed non-significant results (MRC, SHEP, SCOPE, HYVET-COG). This discrepancy emphasizes the difficulty to perform such trials: the follow-up has to be long enough to disclose a benefit, a large number of patients is needed for these studies, and because of ethical reasons some anti-hypertensive treatments are often prescribed in the placebo group. Results of the two more recent meta-analyses are inconsistent, possibly due to methodological issues. Antihypertensive treatments could be beneficial to cognitive function by lowering blood pressure and/or by specific neuroprotective effect. Three main antihypertensive subclasses have been associated with a beneficial effect on cognitive function beyond blood pressure reduction (calcium channel blockers, angiotensin converting enzyme inhibitor, angiotensin-AT1-receptor-blockers). Further long-term randomized trials, designed especially to assess a link between antihypertensive therapy and cognitive decline or dementia are therefore needed with cognition as the primary outcome. A low blood pressure threshold that could be deleterious for cognitive function should also be determined.

Authors+Show Affiliations

Department of Geriatrics, University Paris- Descartes, Broca Hospital, AP-HP, France. emmanuelle.duron@brc.aphp.frNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20182022

Citation

Duron, Emmanuelle, and Olivier Hanon. "Antihypertensive Treatments, Cognitive Decline, and Dementia." Journal of Alzheimer's Disease : JAD, vol. 20, no. 3, 2010, pp. 903-14.
Duron E, Hanon O. Antihypertensive treatments, cognitive decline, and dementia. J Alzheimers Dis. 2010;20(3):903-14.
Duron, E., & Hanon, O. (2010). Antihypertensive treatments, cognitive decline, and dementia. Journal of Alzheimer's Disease : JAD, 20(3), 903-14. https://doi.org/10.3233/JAD-2010-091552
Duron E, Hanon O. Antihypertensive Treatments, Cognitive Decline, and Dementia. J Alzheimers Dis. 2010;20(3):903-14. PubMed PMID: 20182022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antihypertensive treatments, cognitive decline, and dementia. AU - Duron,Emmanuelle, AU - Hanon,Olivier, PY - 2010/2/26/entrez PY - 2010/2/26/pubmed PY - 2010/9/9/medline SP - 903 EP - 14 JF - Journal of Alzheimer's disease : JAD JO - J. Alzheimers Dis. VL - 20 IS - 3 N2 - Chronic hypertension is associated with an increased risk of both vascular dementia and Alzheimer's disease (AD). In this context, the role of anti-hypertensive therapy for the prevention and delay of cognitive decline and dementia is of central importance. Most longitudinal studies have shown a significant inverse association between anti-hypertensive therapies and dementia incidence and for some of these, particularly in AD. Seven randomized, double blind placebo-controlled trials have evaluated the benefit of antihypertensive treatments on cognition. Three of them found positive results in term of prevention of dementia (SYST-EUR) or cognitive decline (PROGRESS, HOPE). Others disclosed non-significant results (MRC, SHEP, SCOPE, HYVET-COG). This discrepancy emphasizes the difficulty to perform such trials: the follow-up has to be long enough to disclose a benefit, a large number of patients is needed for these studies, and because of ethical reasons some anti-hypertensive treatments are often prescribed in the placebo group. Results of the two more recent meta-analyses are inconsistent, possibly due to methodological issues. Antihypertensive treatments could be beneficial to cognitive function by lowering blood pressure and/or by specific neuroprotective effect. Three main antihypertensive subclasses have been associated with a beneficial effect on cognitive function beyond blood pressure reduction (calcium channel blockers, angiotensin converting enzyme inhibitor, angiotensin-AT1-receptor-blockers). Further long-term randomized trials, designed especially to assess a link between antihypertensive therapy and cognitive decline or dementia are therefore needed with cognition as the primary outcome. A low blood pressure threshold that could be deleterious for cognitive function should also be determined. SN - 1875-8908 UR - https://www.unboundmedicine.com/medline/citation/20182022/Antihypertensive_treatments_cognitive_decline_and_dementia_ L2 - https://content.iospress.com/openurl?genre=article&id=doi:10.3233/JAD-2010-091552 DB - PRIME DP - Unbound Medicine ER -