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International Journal of HypertensionVolume 2012 2012, Article ID 320648, 6 pages

Review Article

Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime 791-0295, Japan

Proteo-Medicine Research Center, Ehime University, Ehime 791-0295, Japan

Received 12 August 2011; Accepted 19 September 2011

Academic Editor: Blas Gil Extremera

Copyright © 2012 Michiya Igase et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hypertension HT and dementia are common disorders in the elderly. HT in the elderly is associated with increased occurrence rates of dementia including Alzheimer-s disease AD and vascular dementia VaD. In connection to this, some studies have suggested that HT in old age correlates with the pathogenesis of dementia. Since HT is potentially reversible, a number of randomized trials have examined whether antihypertensive treatment may help in preventing dementia occurrence. We review five studies, all using subjects 60 years or older, which investigated different antihypertensive pharmacological treatments. Data from two trials Syst-Eur, PROGRESS open the way toward the prevention of dementia AD or VaD by antihypertensive treatments. In the Syst-Eur study, with the dihydropyridine calcium antagonists, a reduction in both types of dementia was demonstrated risk reduction 55%. The PROGRESS study showed that the use of angiotensin-converting enzyme inhibitors ACEIs, with or without diuretics, resulted in decrease incidence of stroke-related dementia risk reduction 19%, but dementia without stroke was not reduced. In contrast, the SHEP trial, treatment with a chlorthalidone-based antihypertensive regimen, did not significantly reduced the incidence of dementia. The SCOPE study candesartan or hydrochlorothiazide versus placebo and the HYVET-COG study indapamide or perindopril versus placebo found no significant difference between the active treatment and placebo group on the incidence of dementia. We found conflicting results regarding treatment benefits in dementia prevention. Recent clinical trials and studies on animal models suggest that blockades of RAS system could have reduced cognitive decline seen in Alzheimer-s disease and vascular dementia. Future trials primarily designed to investigate the effects of antihypertensive agents on impaired cognition are needed.





Autor: Michiya Igase, Katsuhiko Kohara, and Tetsuro Miki

Fuente: https://www.hindawi.com/



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