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Current Hypertension Reports
Published in: Current Hypertension Reports 6/2012

01-12-2012 | Special Situations in the Management of Hypertension (T Kotchen, Section Editor)

Hypertension and Mild Cognitive Impairment

Authors: Cristina Sierra, Mónica Doménech, Miguel Camafort, Antonio Coca

Published in: Current Hypertension Reports | Issue 6/2012

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Abstract

The brain is an early target for organ damage due to high blood pressure. Hypertension is the major modifiable risk factor for stroke and small vessel disease. It has been suggested that cerebral microvascular disease contributes to vascular cognitive impairment. The mechanisms underlying hypertension-related cognitive changes are complex and not yet fully understood. Both high and, especially in the elderly, low blood pressure (BP) have been linked to cognitive decline and dementia. There is some evidence that antihypertensive drug treatment could play a role in the prevention of cognitive impairment through BP control. The BP levels that should be targeted to achieve optimal perfusion while preventing cognitive decline are still under debate.
Literature
1.
• O’Donnell M, Teo K, Gao P, et al. Cognitive impairment and risk of cardiovascular events and mortality. Eur Heart J. 2012;33:1777–86. First prospective study that shows a relationship between cognitive impairment and CV diseases.PubMedCrossRef
2.
Viswanathan A, Rocca WA, Tzourio C. Vascular risk factors and dementia. How to move forward? Neurology. 2009;72:368–74.PubMedCrossRef
3.
Mancia G, De Backer G, Dominiczak A, et al. 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. 2007;25:1105–87.PubMedCrossRef
4.
Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121–58.PubMedCrossRef
5.
Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–84.PubMedCrossRef
6.
•• Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701. A complete review about cerebral small vessel disease.PubMedCrossRef
7.
Henskens LH, van Oostenbrugge RJ, Kroon AA, et al. Detection of silent cerebrovascular disease refines risk stratification of hypertensive patients. J Hypertens. 2009;27:846–53.PubMedCrossRef
8.
•• Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010;341:c3666. doi:10.​1136/​bmj.​c3666. The only paper to analyze clinical evidences about WML until now.PubMedCrossRef
9.
Rutan GH, Hermanson B, Bild DE, et al. Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension. 1992;19:508–19.PubMedCrossRef
10.
•• Nagai M, Hoshide S, Ishikawa J, et al. Visit-to-visit blood pressure variations: new independent determinants for cognitive function in the elderly at high risk of cardiovascular disease. J Hypertens. 2012;30:1556–63. First study that shows a relationship between visit-to-visit BP variability and cognitive decline.PubMedCrossRef
11.
Qiu C, Winblad B, Fratiglioni L. The age dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4:487–99.PubMedCrossRef
12.
Novak V, Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol. 2010;7:686–98.PubMed
13.
•• Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(9):2672–713. Last review about cognitive impairment from the American Stroke Association.PubMedCrossRef
14.
Launer LJ. Demonstrating the case that AD is a vascular disease: epidemiologic evidence. Aging Res Rev. 2002;1:61–77.CrossRef
15.
Sierra C, Coca A, Schiffrin EL. Vascular mechanisms in the pathogenesis of stroke. Curr Hypertens Rep. 2011;13:200–7.PubMedCrossRef
16.
Jellinger KA, Attems J. Incidence of cerebrovascular lesions in Alzheimer’s disease: a postmortem study. Acta Neuropathol. 2003;105:14–7.PubMed
17.
McCarron MO, Nicoll JA. Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol. 2004;3:484–92.PubMedCrossRef
18.
Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology. 2006;66:165–71.PubMedCrossRef
19.
Imaoka K, Kobayashi S, Fujihara S, et al. Leukoencephalopathy with cerebral amyloid angiopathy: a semiquantitative and morphometric study. J Neurol. 1999;246:661–6.PubMedCrossRef
20.
21.
O’Brien JT, Erkinjuntii E, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003;2:89–93.PubMedCrossRef
22.
Cacciatore F, Abete P, Ferrara N, et al. The role of blood pressure in cognitive impairment in an elderly population. J Hypertens. 1997;15:135–42.PubMedCrossRef
23.
Elias MF, Wolf PA, D’Agostino RB, et al. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993;138:353–64.PubMed
24.
Launer LJ, Masaki K, Petrovitch H, et al. The association between midlife blood pressure levels and late-life cognitive function. JAMA. 1995;274:1846–51.PubMedCrossRef
25.
Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment; a 20-year follow-up of 999 men. Hypertension. 1998;31:780–6.PubMedCrossRef
26.
Carmelli D, Swan GE, Reed T, et al. Midlife cardiovascular risk factors, ApoE, and cognitive decline in elderly male twins. Neurology. 1998;50:1580–5.PubMedCrossRef
27.
Farmer ME, Kittner SJ, Abbott RD, et al. Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. J Clin Epidemiol. 1990;43:475–80.PubMedCrossRef
28.
Forette F, Seux ML, Staessen JA, et al. The prevention of dementia with antihypertensive treatment. New evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002;162:2046–52.PubMedCrossRef
29.
Sierra C, Coca A. Silent cerebral damage in hypertension. Curr Hypertens Rev 2007;3:83–8.
30.
Vermeer SE, Hollander M, van Dijk EJ. et al; Rotterdam Scan Study. Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke. 2003;34:1126–9.PubMedCrossRef
31.
Kuller LH, Longstreth WT, Arnold AM, Cardiovascular Health Study Collaborative Research Group, et al. White matter hyperintensity on cranial magnetic resonance imaging. A predictor of stroke. Stroke. 2004;35:1821–5.PubMedCrossRef
32.
Miyao S, Takano A, Teramoto J, Takahashi A. Leukoaraiosis in relation to prognosis for patients with lacunar infarction. Stroke. 1992;23:1434–8.PubMedCrossRef
33.
Fu JH, Lu CZ, Hong Z, et al. Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischemic stroke. J Neurol Neurosurg Psychiatry. 2005;76:793–6.PubMedCrossRef
34.
Schmidt R, Fazekas F, Offenbacher H, et al. Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals. Arch Neurol. 1991;48:417–20.PubMedCrossRef
35.
De Groot JC, de Leeuw FE, Oudkerk M, et al. Periventricular cerebral white matter lesions predict rate of cognitive decline. Ann Neurol. 2002;52:335–41.PubMedCrossRef
36.
Longstreth WT, Manolio TA, Arnold A, Cardiovascular Health Study Collaborative Research Group, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996;27:1274–82.PubMedCrossRef
37.
Breteler MMB, van Swieten JC, Bots ML, et al. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study. Neurology. 1994;44:1246–52.PubMedCrossRef
38.
Prins ND, van Dijk EJ, den Heijer T, et al. Cerebral white matter lesions and the risk of dementia. Arch Neurol. 2004;61:1531–4.PubMedCrossRef
39.
De Groot JC, de Leeuw FE, Oudkerk M, et al. Cerebral white matter lesions and cognitive function: the Rotterdam scan study. Ann Neurol. 2000;47:145–51.PubMedCrossRef
40.
Sierra C, de la Sierra A, Salamero M, et al. Silent cerebral white matter lesions and cognitive function in middle-aged essential hypertensive patients. Am J Hypertens. 2004;17:529–34.PubMedCrossRef
41.
Kuller LH, Lopez OL, Newman A, et al. Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology. 2003;22:13–22.PubMedCrossRef
42.
Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996;347:1141–5.PubMedCrossRef
43.
44.
Cuspidi C, Meani S, Salerno M, et al. Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study. J Hum Hypertens. 2004;18:503–9.PubMedCrossRef
45.
Kanemaru A, Kanemaru K, Kuwajima I. The effects of short-term blood pressure variability and nighttime blood pressure levels on cognitive function. Hypertens Res. 2001;24:19–24.PubMedCrossRef
46.
Yamamoto Y, Akiguchi I, Oiwa K, et al. The relationship between 24-hour blood pressure readings, subcortical ischemic lesions and vascular dementia. Cerebrovasc Dis. 2005;19:302–8.PubMedCrossRef
47.
Sakakura K, Ishikawa J, Okuno M, et al. Exaggerated ambulatory blood pressure variability is associated with cognitive dysfunction in the very elderly and quality of life in the younger elderly. Am J Hypertens. 2007;20:720–7.PubMedCrossRef
48.
•• Scuteri A, Nilsson PM, Tzourio C, et al. Microvascular brain damage with aging and hypertension: pathophysiological consideration and clinical implications. J Hypertens. 2011;29:1469–77. Brief but complete review about microvascular brain damage and hypertension, with considerations about things to do in the future to improve understanding.PubMedCrossRef
49.
Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006;37:2220–41.PubMedCrossRef
50.
Nasreddine ZS, Phillips NA, Bedirian C, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.PubMedCrossRef
51.
52.
Birns J, Markus H, Kalra L. Blood pressure reduction for vascular risk: is there a price to be paid? Stroke. 2005;36:1308–13.PubMedCrossRef
53.
Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. Arch Intern Med. 1993;153:598–615.PubMedCrossRef
54.
Domanski MJ, Davis BR, Pfeffer MA, et al. Isolated systolic hypertension. Prognostic information provided by pulse pressure. Hypertension. 1999;34:375–80.PubMedCrossRef
55.
Laurent S, Katsahian S, Fassot C, et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke. 2003;34:1203–6.PubMedCrossRef
56.
Kim CK, Lee SH, Kim BJ, et al. Age-independent association of pulse pressure with cerebral white matter lesions in asymptomatic elderly individuals. J Hypertens. 2011;29:325–9.PubMedCrossRef
57.
Scuteri A, Tesauro M, Appolloni S, et al. Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual. J Hypertens. 2007;25:1035–40.PubMedCrossRef
58.
Waldstein SR, Rice SC, Thayer JF, et al. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension. 2008;51:99–104.PubMedCrossRef
59.
Poels MM, van Oijen M, Mattace-Raso FU, et al. Arterial stiffness, cognitive decline, and risk of dementia: the Rotterdam study. Stroke. 2007;38:888–92.PubMedCrossRef
60.
O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46:200–4.PubMedCrossRef
61.
Barzilay JI, Gao P, O’Donnell M, et al. Albuminuria and decline in cognitive function. The ONTARGET/TRANSCEND Studies. Arch Intern Med. 2011;171:142–50.PubMedCrossRef
62.
Barzilay JI, Fitzpatrick AL, Luchsinger J, et al. Albuminuria and dementia in the elderly: a community study. Am J Kidney Dis. 2008;52:216–26.PubMedCrossRef
63.
Wong TY, Klein R, Sharrett AR, et al. Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis risk in Communities study. Stroke. 2002;33:1487–92.PubMedCrossRef
64.
Baker ML, MarinoLarsen EK. KullerLH, et al. Retinal microvascular signs, cognitive function, and dementia in older persons: the Cardiovascular Health Study. Stroke. 2007;38:2041–7.PubMedCrossRef
65.
SHEP Cooperative Research Group. 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. 1991;24:3255–64.CrossRef
66.
Staessen JA, Fagard R, Thijs L, et al. For the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350:757–64.PubMedCrossRef
67.
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;163:1069–75.CrossRef
68.
Lithell H, Hansson L, Skoog I, et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens. 2003;21:875–88.PubMedCrossRef
69.
Staessen JA, Richart T, Birkenhäger WH. Less atherosclerosis and lower blood pressure for a meaningful life perspective with more brain. Hypertension. 2007;49:389–400.PubMedCrossRef
70.
•• Peters R, Beckett N, Forette F, HYVET Investigators, 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;7:683–9. Includes a meta-analysis about main published trials about cognitive impairment.PubMedCrossRef
71.
Diener HC, Sacco RL, Yusuf S, et al. for the PRoFESS Study Group. 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. 2008;7:875–84.PubMedCrossRef
72.
Sleight P, Redon J, Verdecchia P, et al. for the ONTARGET Investigators. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009;27:1360–9.PubMedCrossRef
73.
Pendlebury ST, Cuthbertson FC, Welch SJ, et al. Underestimation of cognitive impairment by mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010;41:1290–3.PubMedCrossRef
74.
Oveisgharan S, Hachinski V. Hypertension, executive dysfunction, and progression to dementia: the Canadian study of health and aging. Arch Neurol. 2010;67:187–92.PubMedCrossRef
75.
Dufouil C, Chalmers J, Coskun O, et al. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke. The PROGRESS Magnetic resonance imaging substudy. Circulation. 2005;112:1644–50.PubMedCrossRef
Metadata
Title
Hypertension and Mild Cognitive Impairment
Authors
Cristina Sierra
Mónica Doménech
Miguel Camafort
Antonio Coca
Publication date
01-12-2012
Publisher
Current Science Inc.
Published in
Current Hypertension Reports / Issue 6/2012
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-012-0315-2

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