Effects of Blood Pressure Changes on Alzheimer’s Disease

Abstract

Alzheimer’s disease is the most frequent cause of dementia. Whereas other major causes of death have been decreasing, the number of deaths due to Alzheimer’s disease is rising. As there is no cure for this type of dementia at present, preventive measures have assumed great importance. By analyzing data from available longitudinal studies, the current review presents evidence supporting a link between Alzheimer’s disease and blood pressure changes.

Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease

“…Overall, our results support findings from other studies associating midlife arterial hypertension with decreased late-life cognitive performance [36], while mildly higher BP in older people is inversely related to risk of dementia [1]. …”

“…Arterial hypertension leads to remodeling of cerebral arteries that reduces their lumen and contributes to cerebral hypoperfusion, further aggravated by hypotension due to decreased noradrenergic mechanisms in AD; cerebral hypoperfusion increases amyloid precursor protein expression and generation of amyloid-β [1]. Patients with arterial hypertension are more vulnerable to hypotension due to a shift in the threshold of BP at which the cerebral blood flow is sustained; thus, hypotension may cause memory decline and increases in cerebrospinal fluid phospho-tau in older people with previously high BP and no dementia [29].…”

“…In patients with mild cognitive impairment, diuretic use seems to have a differential benefit of reduced AD risk [35]. Nevertheless, most studies have shown conflicting results regarding the effects of distinct classes of antihypertensives on the incidence or course of AD [1], possibly due to specific characteristics of the populations studied - recently, one study reported more benefits from renin-angiotensin system modulation for African Americans than for Caucasians [36]. Anyhow, no class of BP-lowering medication caused significant differences in variations of BP or any test scores in our sample.…”

“…Senescence-related cognitive changes may result from reduced brain circulation [1] leading to continuous hypoperfusion that increases generation of amyloid-β [2], particularly in the limbic and association cortices in APOE4+ carriers [3]. Neurodegenerative mechanisms result in loss of noradrenergic cell bodies in the locus ceruleus that may lead to hypotension due to decreased concentration of norepinephrine in the brain [4]; thus, mildly elevated blood pressure (BP) seems to benefit mental and physical functions in older people, while low and higher BP values are associated with poorer performance [5].…”

Prevention of Vascular Cognitive Impairment

“…78,314,315 Physiological risk factors Hypertension There is strong evidence that long-standing hypertension in midlife increases the risk of cognitive impairment and dementia in late-life, whereas the association between hypertension in late-life and dementia is less consistent. 95,177,316 Blood pressure (BP) values frequently drop in late-life and this drop has been reported to be stronger in subjects with dementia than in non-demented subjects. 90 A J-or U-shaped relation with late-life cognitive decline has been found for systolic BP (SBP) and to a lesser degree for diastolic BP.…”