Pharmacology & Therapeutics ( IF 12.0 ) Pub Date : 2023-12-03 , DOI: 10.1016/j.pharmthera.2023.108575 Mara Lyon 1 , Josie L Fullerton 1 , Simon Kennedy 1 , Lorraine M Work 1
Dementia is a common cause of disability and dependency among the elderly due to its progressive neurodegenerative nature. As there is currently no curative therapy, it is of major importance to identify new ways to reduce its prevalence. Hypertension is recognised as a modifiable risk factor for dementia, particularly for the two most common subtypes; vascular dementia (VaD) and Alzheimer's disease (AD). From the current literature, identified through a comprehensive literature search of PubMed and Cochrane Library, this review aims to establish the stage in adulthood when hypertension becomes a risk for cognitive decline and dementia, and whether antihypertensive treatment is effective as a preventative therapy.
Observational studies generally found hypertension in mid-life (age 45-64) to be correlated with an increased risk of cognitive decline and dementia incidence, including both VaD and AD. Hypertension manifesting in late life (age 65) was demonstrated to be less of a risk, to the extent that incidences of high blood pressure (BP) in the very elderly (age 75) may even be related to reduced incidence of dementias. Despite the evidence linking hypertension to dementia, there were conflicting findings as to whether the use of antihypertensives was beneficial for its prevention and this conflicting evidence and inconsistent results could be due to the methodological differences between the reviewed observational and randomised controlled trials. Furthermore, dihydropyridine calcium channel blockers and potassium-sparing diuretics were proposed to have neuroprotective properties in addition to BP lowering. Overall, if antihypertensives are confirmed to be beneficial by larger-scale homogenous trials with longer follow-up durations, treatment of hypertension, particularly in mid-life, could be an effective strategy to considerably lower the prevalence of dementia. Furthermore, greater clarification of the neuroprotective properties that some antihypertensives possess will allow for better clinical practice guidance on the choice of antihypertensive class for both BP lowering and dementia prevention.
中文翻译:
高血压和痴呆:病理生理学和抗高血压药在减轻疾病负担方面的潜在效用
由于其进行性神经退行性,痴呆症是老年人残疾和依赖的常见原因。由于目前没有治愈方法,因此寻找新的方法来降低其患病率非常重要。高血压被认为是痴呆症的一个可改变的危险因素,特别是对于两种最常见的亚型;血管性痴呆(VaD)和阿尔茨海默病(AD)。通过对 PubMed 和 Cochrane 图书馆的全面文献检索确定的现有文献,本综述旨在确定成年期高血压成为认知能力下降和痴呆风险的阶段,以及抗高血压治疗作为预防性治疗是否有效。
观察性研究普遍发现,中年(45-64 岁)高血压与认知能力下降和痴呆(包括 VaD 和 AD)发病风险增加相关。高血压表现在晚年(年龄65)被证明风险较小,以至于老年人(年龄