Essential hypertension, dementia, and antihypertensive therapy in geriatric patients

Cite item

Full Text


The review summarizes the current views on the pathogenesis of dementia and the significance of blood pressure levels for its development. The present status of the prevention of cognitive disorders and dementia is detailed in the use of antihypertensive therapy: there are the data of prospective cohort studies of the impact of antihypertensive therapy on the risk of dementia, the results of placebo-controlled studies in the groups of elderly and senile patients with a history of cerebrovascular complications, and the data of meta-analyses of studies. As for cognitive function, the effects of different classes of the currently available antihypertensive agents, such as diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor antagonists, are analyzed.


  1. Ferri C. P., Prince M., Brayne C. et al. Alzheimer's disease international. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366: 2112-2117.
  2. World Health Organization. World health report 2003: shaping the future. Geneva: World Health Organization; 2003.
  3. Lobo A., Launer L., Fratiglioni L. et al. For the neurologic diseases in the elderly research group. Prevalence of dementia and major subtypes in Europe: a collaborative study of population based- chorts. Neurology 2000; 54: S4-S9.
  4. Schneider J., Murray J., Banergee S., Mann A. EUROCARE: a cross-national study of co-resident spouse carers of people with Alzheimer's disease. J. Geriatr Psychiatry 1999; 14: 651-661.
  5. Skoog I., Lernfelt B., Landahl S. et al. A 15 year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141-1145.
  6. Qiu C., Winblad B., Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005; 4: 487-499.
  7. Birns J., Morris R., Donaldson N., Kalra L. The effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials. J. Hypertens. 2006; 24: 1907-1914.
  8. Launer L. J., Masaki K., Petrovitch H. et al. The association between midlife blood pressure levels and late-life cognitive function: the Honolulu-Asia aging study. J. A. M. A. 1995; 274 (23): 1846-1851.
  9. Korf E. S. C., White L. R., Scheltens P., Launer L. J. Midlife blood pressure and the risk for hippocampal atrophy: the Honolulu-Asia aging study. Hypertension 2004; 44: 29-34.
  10. Khachaturian A. S., Zandi P. P., Lyketsos C. G. et al. Antihypertensive medication use and incidence of Alzheimer disease. Arch. Neurol. 2006; 63: 686-692.
  11. Fratiglioni L., Viitanen M., Backman L. et al. Occurrence of dementia in advanced age: the study design of the Kungsholmen project. Neuroepidemiology 1992; 11 (S1): 29-36.
  12. Guo Z., Fratiglioni L., Zhu L. et al. Occurrence and progression of dementia in a community population aged 75 years and older: relationship of antihypertensive medication use. Arch. Neurol. 1999; 56 (8): 991-996.
  13. Peila R., White L. R., Masaki K. et al. Reducing the risk of dementia: efficacy of long-term treatment of hypertension. Stroke 2006; 37: 1165-1170.
  14. Murray M. D., Lane K. A., Evans R. M. et al. Preservation of cognitive function with antihypertensive medications: a longitudinal analysis of a community-based sample of African Americans. Arch. Intern. Med. 2002; 162: 2090-2096.
  15. Forette F., Seux M. L., Staessen J. A. et al. Prevention of dementia in randomised double-blind placebo-controlled systolic hypertension in Europe (Syst.-Eur.) trial. Lancet. 1998; 352: 1347-1351.
  16. Forette F., Seux M. L., Staessen J. A. et al. Reduction of dementia by calcium-antagonist-based antihypertensive treatment. Eur. Heart. J. 2000; 2 (suppl.): D17-19.
  17. Forette F., Seux M. L., Staessen J. A. et al. The prevention of dementia with antihypertensive treatment, new evidence from the systolic hypertension in Europe (Syst-Eur) study. Arch. Intern. Med. 2002; 162: 2046-2052.
  18. Lithell H., Hansson L., Skoog I. et al. For the SCOPE Study Group. The study on cognition and prognosis in the elderly (SCOPE): principal results of a randomised double-blind intervention trial. J. Hypertens. 2003; 21: 875-886.
  19. Lithell H., Hansson L., Skoog I. et al. For the SCOPE Study Group. The study of cognition and prognosis in the elderly (SCOPE): outcomes in patients not receiving add-on therapy after randomization. J. Hypertens. 2004; 22 (8): 1605-1612.
  20. Applegate W. B., Pressel S., Wittes J. et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the systolic hypertension in the elderly program. Arch. Intern. Med. 1994; 154: 2154-2160.
  21. Di Bari M., Pahor M., Franse L. V. et al. Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial. Am. J. Epidemiol. 2001; 153: 72-78.
  22. The PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch. Intern. Med. 2003; 163: 1069-1075.
  23. Peters R., Beckett N., Forette F. et al. 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. 2008; 7 (8): 683-689.
  24. Toescu E. C., Verkhratsky A., Landifield P. W. Ca2+ regulation and gene expression in normal brain aging. Trends Neurosci. 2004; 27: 614-620.
  25. Rendu F., Bachelot C., Molle D. et al. Indapaimide inhibits platelet aggregation in vitro: comparison to hydrochlorothiazide. J. Cardiovasc. Pharmacol. 1993; 22 (suppl. 6): S57-S63.
  26. Nishioku T., Takata F., Yamauchi A. et al. Protective action of indapamide, a thiazide-like diuretic, on ischemia-induced injury and barrier dysfunction in mouse brain microvascular endothelial cells. J. Pharmacol. Sci. 2007; 103 (3): 323-327.
  27. Maxwell C. J., Hogan D. B., Ebly E. M. Calcium-channel blockers and cognitive function in elderly people: results from the Canadian study of health and aging. Can. Med. Assoc. J. 1999; 161 (5): 501-506.
  28. Trompet S., Westendorp R. G., Kamper A. M., de Craen A. J. Use of calcium antagonists and cognitive decline in old age: the Leiden 85-plus study. Neurobiol. Aging. 2008; 29 (2): 306-308.
  29. Savaskan E., Hock C., Olivieri G. et al. Cortical alterations of angiotensin converting enzyme, angiotensin II and AT1 receptor in Alzheimer's dementia. Neurobiol. Aging. 2001; 22 (4): 541-546.
  30. Gard P. R., Rusted J. M. Angiotensin and Alzheimer's disease: therapeutic prospects. Expert. Rev. Neurother. 2004; 4 (1): 87-96.
  31. Hanes D. S., Weir M. R. Usefulness of ARBs and ACE inhibitors in the prevention of vascular dementia in the elderly. Am. J. Geriatr. Cardiol. 2007; 16 (3): 175-182.
  32. Barnes N. M., Cheng C. K., Costal B. et al. Angiotensin converting enzyme density is increased in temporal cprtex from patients with Alzheimer's disease. Eur. J. Pharmacol. 1991; 200: 289-292.
  33. Kehoe P. G., Wilcock G. K. Is inhibition of the renin-angiotensin system a new treatment option for Alzheimer's disease? Lancet Neurol. 2007; 6 (4): 373-378.
  34. Ohrui T., Matsui T., Yamaya M. et al. Angiotensin-converting enzyme inhibitors and incidence of Alzheimer's disease in Japan. J. Am. Geriatr. Soc. 2004; 52 (4): 649-650.
  35. Ohrui T., Tomita N., Sato-Nalcagawa T. et al. Effects of brain-penetrating ACE inhibitors on Alzheimer disease progression. Neurology 2004; 63: 1324-1325.

Copyright (c) 2009 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail:


© 2018-2021 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies