Hypertension: Middle-Age HBP Major Cause AD: 3703 Japanese-American men Honolulu Heart Program (HHP;1965-1971), examined in 1991 for dementia. Among those never treated for HBP (57% of sample!), the risk for dementia was OR 3.8 for DBP of 90-94 mmHg, and 4.3 for DBP of 95 mmHg and over compared to those with DBP of 80 to 89 mmHg. Compared to those with SBP of 110 to 139 mmHg, the risk for dementia was 4.8 in those with SBP 160 mmHg and higher. BP not associated with the risk for dementia in treated men. Study suggests elevated levels of blood pressure in middle age can increase the risk for late age dementia in men never treated with anti-hypertensive medication. Neurobiol Aging. 2000 Jan

Increased BP Linked to Hippocampal Atrophy: The hippocampus is vulnerable to global ischemia, which may lead to atrophy. In a sample of Japanese-American men with 30 year follow-up with brain MRIs, adjusting for sociodemographic factors, other cardiovascular risk factors, apolipoprotein E allele, and correlated brain pathology, those never treated with antihypertensive medication had a significantly increased risk for hippocampal atrophy of 70% (OR 1.7). For high systolic BP it was OR=1.98 and for high diastolic BP (>90 mmHg) OR=3.51. Midlife blood pressure and the risk of hippocampal atrophy: the Honolulu Asia Aging Study. Korf ES, White LR, Scheltens P, Launer LJ. Universiteit Medical Center, Amsterdam. Hypertension. 2004 Jul;44(1):29-34

Reduced Blood Flow Linked to Dementia: In 27 adults with Alzheimer's disease (AD), seven with frontotemporal dementia (FTD), six with vascular dementia (VaD), and 12 normal controls, a close coupling was evident between reduced regional cerebral blood flow and dementia. Relationship between cognitive function and regional cerebral blood flow in different types of dementia. Osawa A, Maeshima S, Shimamoto Y, Maeshima E, Sekiguchi E, Kakishita K, Ozaki F, Moriwaki H. Kawasaki Medical School, Japan. Disabil Rehabil. 2004 Jun 17;26(12):739-45.

ACE Inhibitor Captopril May Be Better at Preventing Cognitive Deterioration: In a 1-year Japanese random assignment study of 162 patients with cognitive impairment and high blood pressure, those treated with brain-penetrating ACE inhibitors captopril or perindopril had only a 0.6 decline in their MMSE score vs. a 4.6 point decline with non-penetrating ACE inhibitors enalapril or imidapril and a 4.9 point decline with calcium channel blockers. Tokohu University, Neurol 10/2004. Ed: This study was not blinded, so needs to be repeated with more patients using a double-blind design. Captopril is very inexpensive costing about $3 per month (50 mg b.i.d.) wholesale and $13 per month retail. Perindopril (Aceon) is not available in the U.S. and costs $20 per month from Canada.

Hypertension, Obesity Lead to Cognitive Impairment: Framingham 18yr f/u 1423 adults free of dementia, heart disease and stroke. Each factor independent predictor. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Elias MF, Elias PK, Sullivan LM, Wolf PA, D'Agostino RB. Int J Obes Relat Metab Disord 2003 Feb;27(2):260-8

Hypertenstion: Middle-Age Systolic HBP & Cholesterol Major AD Risk Factors: followed 1449 Finnish men and women over an average of 21 years and found that after adjusting for age, body mass index, education, vascular events, smoking status and alcohol consumption, the odds ratio for developing Alzheimer's in later life was 2.3 for raised systolic blood pressure (>160vs<140) and 2.1 for raised cholesterol. A combination of these factors gave an odds ratio of 3.5. Raised diastolic blood pressure had no significant effect. AD patients were less likely to be alcohol drinkers. BMJ 6/15/01

Hypertension Not Clearly Related: Although vascular disease can lead to dementia, studies have not found any clear link between BP and later dementia. The most recent study of 2000 elderly in Boston found no clear link with BP and dementia 9 years later with minimal increased dementia for both very low blood pressure and high blood pressure. Robert Glynn, JAMA 2/3/99, 281:438-45.

Hyper- or Hypotention: Diastolic Hypotension, Systolic Hypertension Predict Dementia: 6yr f/u 1200 75-101yos. BP <65 diastolic or >180 systolic OR 1.7. Low Blood Pressure and Risk of Dementia in the Kungsholmen Project: A 6-Year Follow-up Study. Qiu C, Von Strauss E, Fastbom J, Winblad B, Fratiglioni L. Arch Neurol 2003 Feb;60(2):223-8 

Blood Pressure if too High Lowers Cognitive Tests: In a 1998 20-year Swedish study of almost 1000 men starting at age 50, researchers found those with HBP, especially uncontrolled, scored lower on cognitive tests. Energy Times 2/99, reference?

Blood Pressure if too Low Associated with Increased Alzheimer's: A diastolic blood pressure below 70 mm Hg is associated with an increased risk of dementia in people over 75.  In a prospective study, 406 community-dwelling elderly who were dementia-free at baseline with 6.7 years of follow-up, 122 subjects developed dementia. For each 10-mm Hg drop in diastolic pressure, dementia increased by 20%. A similar effect was seen with arterial pressure. Low pressures were only linked to an increased risk of Alzheimer's type dementia, not vascular dementia. Compared with other subjects, individuals with consistently low blood pressures throughout the first two years of the study were twice as likely to develop dementia. The researchers stated low BP may be both a cause and consequence of the disease. J. Verghese, Albert Einstein, Neurology 12/23/2003;61:1667-1672. 

Thomas E. Radecki, M.D., J.D.

modern-psychiatry.com

Email: [email protected]