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Medline ® Abstract for Reference 7

of 'Can drug therapy be discontinued in well-controlled hypertension?'

Blood pressure and the risk for dementia: a double edged sword.
Kennelly SP, Lawlor BA, Kenny RA
Ageing Res Rev. 2009 Apr;8(2):61-70. Epub 2008 Nov 21.
Alzheimer's disease (AD) and vascular dementia (VaD) are important causes of cognitive decline in the elderly. As a result of the aging population, the incidence of dementia is expected to increase substantially over the coming decades. Many studies have identified that vascular risk factors are implicated in the pathogenesis of both AD and VaD. Longitudinal studies have suggested that high blood pressure in midlife is associated with a higher incidence of both AD and VaD in later life. The association appears weaker for hypertension in later life. Some studies also suggest that hypotension; especially low diastolic blood pressure in late-life is also associated with an increased risk of AD. Long-standing hypertension may lead to severe atherosclerosis and impaired cerebrovascular autoregulation. A decline in blood pressure in later life may contribute to diminished cerebral perfusion. The subsequent ischaemic state may lead to increased cerebral beta-amyloid accumulation.
Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland. skennelly@stjames.ie