POINT 9
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1
Hypertension in middle age is a risk factor for senile dementia, and it should be aggressively treated from the perspective of dementia prevention. (Recommendation grade: C1, Evidence level: VI)
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2
The prevention of dementia by antihypertensive medication in the elderly has not been proved, but no study has suggested that antihypertensive drugs reduce the cognitive function. Accordingly, antihypertensive drug therapy should be performed. (Recommendation grade: C1, Consensus)
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3
There is little evidence about the effects of antihypertensive drugs on cognitive function in hypertensive patients with dementia, but antihypertensive treatment should be considered. (Recommendation grade: C1, Consensus)
Hypertension is a risk factor for vascular dementia.838,869,870 Alzheimer's disease is also complicated by cerebrovascular disease or cerebral microangiopathy.869 Its association with hypertension has been reported.838,869,870
1. BLOOD PRESSURE AND COGNITIVE DYSFUNCTION/DEMENTIA
The relationship between blood pressure and cognitive dysfunction/dementia depends on age, and differs between middle-aged and elderly persons. Many observational studies have shown that hypertension in middle age is a risk factor for cognitive impairment or dementia in the elderly.24,838,869–872 The Hisayama Study also reported that hypertension in middle age was a significant risk factor for vascular dementia in later life.24 Hypertension in middle-aged persons should be aggressively treated from the perspective of dementia prevention.838,869,870
On the other hand, the relationship between dementia and blood pressure in the elderly is inconclusive. Not only hypertension869 but also hypotension,872,873 orthostatic hypotension872,874 and abnormal diurnal changes in blood pressure875 are associated with dementia. Several studies have investigated the effect of antihypertensive treatment on the development of dementia in the elderly hypertensive patients.830,876–879However, the results were markedly different among the studies,872 and meta-analyses have not reached a conclusion.120,872 One study demonstrated the superiority of ARB in the prevention of dementia.880 Furthermore, several studies have indicated the efficacy of brain-transferable ACE inhibitors.881,882 However, randomized clinical trials have failed to show that ARBs can prevent dementia.878,879 As none of the studies showed that antihypertensive drugs reduce the cognitive function in the elderly, antihypertensive drug therapy should be considered.883
2. HYPERTENSION WITH DEMENTIA
There is little evidence about the effect of antihypertensive drugs in hypertensive patients with dementia. An observational study indicated that antihypertensive drugs prevented the conversion of mild cognitive impairment to Alzheimer's disease.884 Although there is little evidence, strict control of risk factors for arteriosclerosis, including hypertension, should be considered.870 There is no evidence about blood pressure level to be treated, and blood pressure control should be performed in accordance with guidelines for hypertension in the elderly.
Only a few studies have investigated the effect of antihypertensive treatment on the cognitive function in hypertensive patients with dementia, especially Alzheimer's disease. According to studies conducted in Japan, antihypertensive treatment prevented cognitive decline in patients with Alzheimer's disease.885–887 Accordingly, antihypertensive treatment should be considered. In patients with dementia, attention must be particularly paid to adherence, and strategies such as simplification of prescriptions and compliance management by the nursing staff should be conducted (see Chapter 8, Hypertension in the elderly).
Citation Information
We recommend that any citations to information in the Guidelines are presented in the following format:
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res 2014; 37: 253–392.
Please refer to the title page for the full list of authors.
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Chapter 9. Dementia. Hypertens Res 37, 333 (2014). https://doi.org/10.1038/hr.2014.12
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DOI: https://doi.org/10.1038/hr.2014.12
