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Hypertension, Cognitive Decline, and Dementia

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Hypertension and Brain Damage

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

Abstract

A better understanding of the role of vascular factors contributing to the onset and progression of cognitive decline with advancing age is becoming a top priority for research and public health. A large number of studies have reported strong relationships between indices of vascular aging and either cognitive impairment, dementia, or silent cerebral small vessel disease (SVD).

Hypertension is known to be the most important factor for developing cerebral macrovascular complications such as stroke and also microvascular such as white matter lesions, lacunar infarcts, and microbleeds (SVD) and, consequently, vascular dementia or Alzheimer dementia. Results from cross-sectional and longitudinal studies have shown a correlation between high BP and cognitive impairment. Hypertension may also predispose to the development of more subtle cerebral processes based on arteriolar narrowing or pathological microvascular changes. It has been suggested that cerebral microvascular disease contributes to the development of vascular cognitive impairment. Correlations between cerebral white matter lesions and elevated blood pressure provide indirect evidence that structural and functional changes in the brain over time may lead to reduced cognitive functioning when blood pressure control is poor or lacking. In addition, there is some evidence that antihypertensive drug treatment may play a role in the prevention of cognitive impairment, vascular dementia, or Alzheimer dementia through blood pressure control.

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References

  1. Anderson C, Teo K, Gao P, Arima H, Dans A, Unger T et al (2011) Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the ONTARGET and TRANSCEND studies. Lancet Neurol 10(1):43–53

    Article  CAS  PubMed  Google Scholar 

  2. Attems J, Jellinger KA (2014) The overlap between vascular disease and Alzheimer’s disease--lessons from pathology. BMC Med 12:206

    Article  PubMed  PubMed Central  Google Scholar 

  3. Birns J, Kalra L (2009) Cognitive function and hypertension. J Hum Hypertens 23:86–96

    Article  CAS  PubMed  Google Scholar 

  4. Birns J, Markus H, Kalra L (2005) Blood pressure reduction for vascular risk: is there a price to be paid? Stroke 36:1308–1313

    Article  PubMed  Google Scholar 

  5. Bueche CZ, Hawkes C, Garz C, Vielhaber S, Attems J, Knight RT et al (2014) Hypertension drives parenchymal β-amyloid accumulation in the brain parenchyma. Ann Clin Transl Neurol 1:124–129

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cummings JL (1998) Frontal–subcortical circuits and human behavior. J Psychosom Res 44:627–628

    Article  CAS  PubMed  Google Scholar 

  7. Davies NM, Kehoe PG, Ben-Shlomo Y, Martin RM (2011) Associations of anti-hypertensive treatments with Alzheimer’s disease, vascular dementia, and other dementias. J Alzheimers Dis 26:699–708

    PubMed  Google Scholar 

  8. Di Bari M, Pahor M, Franse LV, Shorr RI, Wan JY, Ferrucci L et al (2001) Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial. Am J Epidemiol 153:72–78

    Article  PubMed  Google Scholar 

  9. Diener HC, Sacco RL, Yusuf S, Cotton D, Ounpuu S, Lawton WA, et al. for the PRoFESS Study Group (2008) Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol 7: 875–884

    Google Scholar 

  10. Forette F, Seux ML, Staessen JA, Thijs L, Babarskiene MR, Babeanu S et al (2002) Systolic hypertension in Europe investigators. The prevention of dementia with antihypertensive treatment: new evidence from the systolic hypertension in Europe (syst-Eur) study. Arch Intern Med 162:2046–2052

    Article  PubMed  Google Scholar 

  11. Gorelick PB, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C et al (2011) Vascular contributions to cognitive impairment and dementia. A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:2672–2713

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE et al (2006) National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 37:2220–2241

    Article  PubMed  Google Scholar 

  13. Hajjar I, Goldstein FC, Martin GS, Quyyumi AA (2016) Roles of arterial stiffness and blood pressure in hypertension-associated cognitive decline in healthy adults. Hypertension 67:171–175

    Article  CAS  PubMed  Google Scholar 

  14. Hajjar I, Hart M, Chen YL, Mack W, Milberg W, Chui H et al (2012) Effect of antihypertensive therapy on cognitive function in early executive cognitive impairment: a double-blind randomized clinical trial. Arch Intern Med 172:442–444

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hughes TM, Craft S, Lopez OL (2015) Review of ‘the potential role of arterial stiffness in the pathogenesis of Alzheimer’s disease’. Neurodegener Dis Manag 5:121–135

    Article  PubMed  PubMed Central  Google Scholar 

  16. Iadecola C (2014) Hypertension and dementia. Hypertension 64:3–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Iadecola C, Davisson RL (2008) Hypertension and cerebrovascular dysfunction. Cell Metab 7:476–484

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Imaoka K, Kobayashi S, Fujihara S, Shimode K, Nagasaki M (1999) Leukoencephalopathy with cerebral amyloid angiopathy: a semiquantitative and morphometric study. J Neurol 246:661–666

    Article  CAS  PubMed  Google Scholar 

  19. Jellinger KA, Attems J (2003) Incidence of cerebrovascular lesions in Alzheimer’s disease: a postmortem study. Acta Neuropathol 105:14–17

    PubMed  Google Scholar 

  20. Joas E, Bäckman K, Gustafson D, Ostling S, Waern M, Guo X et al (2012) Blood pressure trajectories from midlife to late life in relation to dementia in women followed for 37 years. Hypertension 59:796–801

    Article  CAS  PubMed  Google Scholar 

  21. Koennecke HC (2006) Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 66:165–171

    Article  PubMed  Google Scholar 

  22. Larson EB, Yaffe K, Langa KM (2013) New insights into the dementia epidemic. N Engl J Med 369:2275–2277

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Launer LJ (2002) Demonstrating the case that AD is a vascular disease: epidemiologic evidence. Ageing Res Rev 1:61–77

    Article  PubMed  Google Scholar 

  24. Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B et al (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 34:1203–1206

    Article  PubMed  Google Scholar 

  25. Li NC, Lee A, Whitmer RA, Kivipelto M, Lawler E, Kazis LE et al (2010) Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis. BMJ 340:b5465. doi:10.1136/bmj.b5465

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B et al (2003) The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 21:875–888

    Article  CAS  PubMed  Google Scholar 

  27. Mawuenyega KG, Sigurdson W, Ovod V, Munsell L, Kasten T, Morris JC et al (2010) Decreased clearance of CNS beta-amyloid in Alzheimer’s disease. Science 330(6012):1774

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. McCarron MO, Nicoll JA (2004) Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol 3:484–492

    Article  PubMed  Google Scholar 

  29. Nasreddine ZS, Phillips NA, Bedirian C, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699

    Article  PubMed  Google Scholar 

  30. Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R et al (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385:2255–2263

    Article  PubMed  Google Scholar 

  31. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C (2014) Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 13:788–794

    Article  PubMed  Google Scholar 

  32. O’Brien JT, Erkinjuntti E, Reisberg B, Roman G, Sawada T, Pantoni L et al (2003) Vascular cognitive impairment. Lancet Neurol 2:89–93

    Article  PubMed  Google Scholar 

  33. O’Rourke MF, Safar ME (2005) Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 46:200–204

    Article  PubMed  Google Scholar 

  34. Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9:689–701

    Article  PubMed  Google Scholar 

  35. Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C, et al. for the HYVET Investigators (2008) Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 7:683–689

    Google Scholar 

  36. Qiu C, Winblad B, Fratiglioni L (2005) The age dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 4:487–499

    Article  PubMed  Google Scholar 

  37. Rodrigue KM, Rieck JR, Kennedy KM, Devous MD Sr, Diaz-Arrastia R, Park DC (2013) Risk factors for β-amyloid deposition in healthy aging: vascular and genetic effects. JAMA Neurol 70:600–606

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B et al (2015) Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 29:113–130

    Article  CAS  PubMed  Google Scholar 

  39. Schrader J, Lüders S, Kulchewski A, Hammersen F, Plate K, Berger J et al (2005) Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention. Principal results of a prospective randomized controlled study (MOSES). Stroke 36:1218–1224

    Article  CAS  PubMed  Google Scholar 

  40. Scuteri A, Nilsson PM, Tzourio C, Redon J, Laurent S (2011) Microvascular brain damage with aging and hypertension: pathophysiological consideration and clinical implications. J Hypertens 29:1469–1477

    Article  CAS  PubMed  Google Scholar 

  41. SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 24:3255–3264

    Google Scholar 

  42. Sierra C, Coca A, Schiffrin EL (2011) Vascular mechanisms in the pathogenesis of stroke. Curr Hypertens Rep 13:200–207

    Article  CAS  PubMed  Google Scholar 

  43. Sierra C, Domenech M, Camafort M, Coca A (2012) Hypertension and mild cognitive impairment. Curr Hypertens Rep 14:548–555

    Article  CAS  PubMed  Google Scholar 

  44. Singer J, Trollor JN, Baune BT, Sachdev PS, Smith E (2014) Arterial stiffness, the brain and cognition: a systematic review. Ageing Res Rev 15:16–27

    Article  PubMed  Google Scholar 

  45. Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson LA, Nilsson L et al (1996) 15-year longitudinal study of blood pressure and dementia. Lancet 347:1141–1145

    Article  CAS  PubMed  Google Scholar 

  46. Snyder HM, Corriveau RA, Craft S, Faber JE, Greenberg SM, Knopman D et al (2015) Vascular contributions to cognitive impairment and dementia including Alzheimer’s disease. Alzheimers Dement 11:710–717

    Article  PubMed  Google Scholar 

  47. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators (1997) Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 350:757–764

    Google Scholar 

  48. Staessen JA, Richart T, Birkenhäger WH (2007) Less atherosclerosis and lower blood pressure for a meaningful life perspective with more brain. Hypertension 49:389–400

    Article  CAS  PubMed  Google Scholar 

  49. The PROGRESS Collaborative Group (2003) Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 163:1069–1075

    Article  Google Scholar 

  50. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Task Force Members (2013) 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31:1281–1357

    Article  CAS  PubMed  Google Scholar 

  51. Viswanathan A, Rocca WA, Tzourio C (2009) Vascular risk factors and dementia. How to move forward? Neurology 72:368–374

    Article  PubMed  PubMed Central  Google Scholar 

  52. Henskens LH, van Oostenbrugge RJ, Kroon AA, Hofman PA, Lodder J, de Leeuw PW (2009) Detection of silent cerebrovascular disease refines risk stratification of hypertensive patients. J Hypertens 27:846–853

    Article  CAS  PubMed  Google Scholar 

  53. Vicario A, Del Sueldo M, Fernández RA, Enders J, Zilberman J, Cerezo GH (2012) Cognition and vascular risk factors: an epidemiological study. Int J Hypertens 2012:783696. doi:10.1155/2012/783696

    Article  PubMed  PubMed Central  Google Scholar 

  54. Folstein MF, Folstein SE, McHugh PR (1975) “Mini mental state” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  55. Vicario A, Martinez CD, Baretto MD, Diaz Casale A, Nicolosi L (2005) Hypertension and cognitive decline: impact on executive function. J Clin Hypertens 7:598–604

    Article  Google Scholar 

  56. Vicario A, Del Sueldo M, Zilberman J, Cerezo G (2011) Cognitive evolution in hypertensive patients: a six years follow-up. Vasc Health Risk Manag 7:1–5

    Google Scholar 

  57. Cerezo GH, Del Sueldo M, Zilberman J, Pawluk M, Lodolo N, De Cerchio AE et al (2015) Cognitive status in hypertensive patients. Heart and brain study in Argentine. J Hypertens 33(Suppl 1):e-57–e-58. doi:10.1097/01.hjh.0000467500.67965.ab

    Article  Google Scholar 

  58. Vicario A, Cerezo GH, Taragano FE, Zilberman J (2013) Guía para la Evaluación de Trastornos Cognitivos en pacientes con enfermedad vascular. Rev Fed Arg Cardiol 42(3) on line. http://www.fac.org.ar/1/revista/13v42n3/exclusivo_online/exclusivo_01/exclusivo_online.pdf

  59. Levi Marpillat N, Macquin-Mavier I, Tropeano AI, Bachoud-Levi AC, Maison P (2013). Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 31:1073-1082

    Google Scholar 

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Author information

Authors and Affiliations

  1. Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic (IDIBAPS), University of Barcelona, Barcelona, Spain

    Cristina Sierra MD, PhD & Ona Escoda

  2. Heart and Brain Unit. Department of Clinical Cardiology, Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina

    Augusto Vicario

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  1. Cristina Sierra MD, PhD
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  2. Augusto Vicario
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  3. Ona Escoda
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Correspondence to Cristina Sierra MD, PhD .

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Editors and Affiliations

  1. Hypertension & Vascular Risk Unit, Hospital Clínic, Barcelona, Spain

    Antonio Coca

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Sierra, C., Vicario, A., Escoda, O. (2016). Hypertension, Cognitive Decline, and Dementia. In: Coca, A. (eds) Hypertension and Brain Damage. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-32074-8_15

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  • DOI: https://doi.org/10.1007/978-3-319-32074-8_15

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