Treatment options and considerations for hypertensive patients to prevent dementia

ABSTRACT

Introduction: Dementia is a worldwide health concern, which leads to loss of autonomy. To date no curative treatment is available so focus on modifiable risk factors is of particular interest. Hypertension, particularly midlife high blood pressure, has been associated with an increased risk for cognitive decline and dementia including vascular dementia (VAD) and Alzheimer disease (AD). In this context, antihypertensive treatments might have a preventive effect.

The objective of this review was to examine the relationship between antihypertensive therapy and cognitive decline or dementia.

Areas covered: A literature search was conducted using PUBMED and the COCHRANE LIBRARY for publications from 1990 onwards mentioning cognitive decline, AD, Vad, mixed dementia, vascular cognitive impairment, hypertension and antihypertensive therapy. Thirty-nine relevant publications including 20 longitudinal studies, 10 randomized-controlled trials and 9 meta-analyses were taken into account.

Expert opinion: Most observational studies have suggested a potential preventive effect of antihypertensive therapies on cognitive decline and dementia, particularly calcium channel blockers and renin-angiotensin system blockers. Randomized clinical trials and meta-analyses provided more conflicting results potentially due to methodological issues.

In conclusion, antihypertensive therapies may reduce cognitive decline and incidence of dementia. Further randomized clinical trials conducted in populations at higher risk of cognitive decline, with longer periods of follow-up and cognition as the primary outcome are still needed.

KEYWORDS:

• Alzheimer’s disease
• antihypertensive therapy
• cognitive decline
• dementia
• hypertension
• longitudinal studies
• meta-analysis
• randomized controlled trials

Article highlights

• The number of worldwide demented subjects is expected to triple from 47.5 million in 2016 to 135 million in 2050 according to the World Health Organization.

• Medications that can prevent dementia or slow down cognitive decline are urgently needed.

• Strong pathophysiological and epidemiological arguments underpin the relationship between high blood pressure and cognitive impairment.

• High blood pressure cause cognitive impairment leading to cerebral vascular lesions (strokes, infarcts, lacunae, white matter lesions) but also leading to cerebral amyloid production and accumulation.

• Various observational, randomized controlled trials and meta-analyses have found positive results concerning prevention of cognitive decline and dementia with antihypertensive therapy use.

• Results of randomized controlled trials on cognition are contradictory, possibly because of methodological limitations.

• The further trials will have to be conducted in populations at high risk of cognitive decline, with longer periods of follow-up and cognition as the primary outcome.

This box summarizes key points contained in the article.

Declaration of interest

O Hanon received consultant/advisory/lecture fees from Daiichi-Sankyo, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb/Pfizer, Novartis, Servier, Astra-Zeneca, Vifor and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.