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A Systematic Review of Reviews to Examine the Association Between Hypertension and Cognitive Impairments in Adults

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Hypertension and the Brain as an End-Organ Target

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Abstract

Background: Essential hypertension is thought to be a risk factor for cognitive impairment. Researchers have proposed several explanations for this link, including endothelial dysfunction/vascular dysregulation, white matter disease, the renin–angiotensin system and inhibition of acetylcholine release by angiotensin II, strategic strokes or tissue loss with strokes, or abnormal insulin signaling. We conducted a review of reviews to investigate the clinical evidence for an association between hypertension and cognitive impairment in adults.

Methods: We included any English-language systematic review or meta-analysis that reported on primary studies conducted in humans aged 18 years or older. The primary studies had to be randomized controlled trials or observational studies with comparison groups. We searched MEDLINE, EMBASE, and PsycINFO from January 1, 2010 to May 23, 2014 to obtain the reviews. We assessed the methodological quality of the included reviews using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) tool.

Results: We included four meta-analyses and one systematic review. Results suggested small associations between hypertension and global cognition, episodic memory, and attention, but no associations between hypertension and language, executive function, information processing speed, and visuoperceptual skills. Results indicated no association between hypertension and Alzheimer’s disease, but a positive association between hypertension and vascular dementia. The overall methodological quality of the included reviews was moderate. Caution is required when interpreting the meta-analyses because the quantitative results were synthesized across different definitions of hypertension and different neuropsychological tests.

Conclusions: Further work is required to understand the association between hypertension and cognitive impairment from a clinical perspective.

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Authors and Affiliations

  1. School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, LHN-3731, Waterloo, ON, Canada, N2L 3G1

    Mark Oremus & Parminder Raina

  2. Department of Pharmacology, Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, 4th floor, Room T-439, Montréal, QC, Canada, H3T 1J4

    Hélène Girouard

  3. Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Chemin Queen-Mary, 4565, Montréal, QC, Canada, H3W 1W5

    Hélène Girouard

Authors
  1. Mark Oremus
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  2. Hélène Girouard
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  3. Parminder Raina
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Correspondence to Parminder Raina .

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Editors and Affiliations

  1. Faculty of Medicine, Université de Montréal, Montréal, Canada

    Hélène Girouard

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Oremus, M., Girouard, H., Raina, P. (2016). A Systematic Review of Reviews to Examine the Association Between Hypertension and Cognitive Impairments in Adults. In: Girouard, H. (eds) Hypertension and the Brain as an End-Organ Target. Springer, Cham. https://doi.org/10.1007/978-3-319-25616-0_1

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