Midlife blood pressure and dementia: the Honolulu–Asia aging study☆

Launer, Lenore J.; Ross, G. Webster; Petrovitch, Helen; Masaki, Kamal; Foley, Dan; White, Lon R.; Havlik, Richard J.

doi:10.1016/s0197-4580(00)00096-8

Cited by 856 publications

(636 citation statements)

References 35 publications

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“…Increasing evidences indicate that brain angiotensin II (AII) and some of its fragments, that is AII [3][4][5][6][7][8] (AIV) and AII, [3][4][5][6][7] either ageing directly or by modulation of the activity of other transmitters, are involved in cognitive processes, including learning and memory. 44,45 Although the role of the brain angiotensins in humans remains to be fully explored, experimental studies have demonstrated that intracerebroventricular administration of AII and its fragments facilitated acquisition in active conditioning trials and retention in a passive avoidance situation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In this context, population risk factors for the development of dementia that are potentially modifiable are important to identify. Evidence from longitudinal studies suggested that hypertension in middle or later age is associated with subsequent cognitive impairment, [4][5][6][7][8] while cross-sectional studies yielded contrasting results. In fact, some authors reported no association between high blood pressure and cognitive impairment, 9,10 some authors found such a relationship only for subjects aged 70 years and over [11][12][13] and other authors observed that higher diastolic (DBP), but not systolic, blood pressure (SBP) values were associated with lower scores in psychometric tests in the elderly.…”

Section: Introductionmentioning

confidence: 99%

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Influence of losartan and atenolol on memory function in very elderly hypertensive patients

et al. 2003

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The aim of this study was to compare the effect of the beta-adrenergic blocker atenolol and the Angiotensin II type 1 (AT1) receptor antagonist losartan on cognitive function in very elderly hypertensive patients. A total of 120 mild to moderate essential hypertensive (DBP 490 and o105 mmHg) patients, aged 75-89 years, were studied. After a 4-week wash-out period on placebo, they were randomized to receive atenolol 50 mg or losartan 50 mg for 24 weeks according to a parallel arm design. At the end of the placebo period and of each active treatment period, BP was measured (by mercury sphygmomanometer, Korotkoff I and V) and cognitive function was evaluated through three different tests (word list memory, word list recall and word list fluency). Both atenolol and losartan were equally effective in reducing SBP (À22.1 and À23.1 mmHg, respectively, Po 0.01 vs baseline) and DBP (À10.3 and À11.2 mmHg, respectively, Po 0.01 vs baseline). Atenolol treatment did not induce significant changes in any test score, whereas losartan significantly increased the score of both the word list memory (+2.2, Po0.05 vs baseline) and the word list recall test (+2.1, Po0.05 vs baseline). The comparison between losartan and atenolol was significant (Po0.05) for both memory tests. These data suggest that in very elderly hypertensive patients, chronic AT1 receptor blockade by losartan could improve cognitive function, in particular immediate and delayed memory.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of losartan and atenolol on memory function in very elderly hypertensive patients

et al. 2003

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“…[1][2][3] Hypertension increases the risk of dementia regardless of type, including Alzheimer's disease. 4,5 In the HOPE and the SYST-EUR studies, treatment of hypertension led to a reduction of cognitive decline of 41 and 50%, respectively. 6,7 The most evident association between blood pressure and cognitive dysfunction is the development of vascular dementia.…”

Section: Introductionmentioning

confidence: 99%

The impact of blood pressure on hippocampal glutamate and mnestic function

et al. 2010

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Hypertension is associated with an increased risk of cognitive decline, which is generally regarded as a consequence of advanced cerebral atherosclerosis. Many hypertensive patients, however, suffer from cognitive decline long before they have any signs of cerebrovascular disease. Therefore, this study examines direct effects of blood pressure on neurotransmitter status in the hippocampus, a vulnerable cerebral structure relevant for memory consolidation. Absolute glutamate concentration and N-acetylaspartate (NAA) concentration as an alternative marker of neuronal integrity were determined in the hippocampus and the cerebral cortex (anterior cingulate cortex; ACC) by 3-T proton magnetic resonance spectroscopy in 16 probands without any history of cerebrovascular disease. Memory function was tested by the auditory verbal learning test (AVLT) and the rivermead behavioural memory test (RBMT). Arterial stiffness was assessed by augmentation index (AI). Mean arterial pressure showed a significant negative age-adjusted correlation to absolute glutamate concentrations in the hippocampus (R ¼ À0.655, P ¼ 0.011), but not in the ACC. There was no significant correlation of mean arterial pressure and NAA in either hippocampus or ACC. AI did not affect hippocampal glutamate. Moreover, there was a significant negative correlation between mean arterial pressure and AVLT (r ¼ À0.558, P ¼ 0.025) and RBMT score (r ¼ À0.555, P ¼ 0.026). There is an inverse relation between blood pressure and the concentration of hippocampal glutamate. Glutamate is essential for long-term potentiation, the neurobiological correlate for memory formation in the hippocampus. Thus, hypertension-associated cognitive decline may not only be mediated by structural atherosclerotic wall changes, but also by functional changes in neurotransmission.

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“…[1][2][3] This suggests that, in addition to being a powerful risk factor for cardiovascular disease, hypertension in elderly patients increases the risk of decline in cognitive function. Active lowering of BP should prevent or reduce cognitive impairment, although not all antihypertensive agents seem to be equally effective in this regard.…”

Section: Introductionmentioning

confidence: 99%

Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients

et al. 2005

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The aim of this study was to compare the effects of telmisartan/hydrochlorothiazide (HCTZ) vs lisinopril/ HCTZ combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. A total of 160 patients, 76 men and 84 women, aged 61-75 years, with sitting diastolic blood pressure (DBP) 490 mmHg and o110 mmHg and systolic blood pressure (SBP) 4140 mmHg were randomized to receive temisartan 80 mg/HCTZ 12.5 mg o.d. or lisinopril 20 mg/HCTZ 12.5 mg o.d. for 24 weeks, according to a prospective, open-label, blinded end point, parallelgroup design. At the end of a 2-week wash-out period and after 12 and 24 weeks of active treatment, 24-h noninvasive ambulatory BP monitoring (ABPM) was performed and cognitive function was evaluated through six different tests (verbal fluency, Boston naming test, word-list memory, word-list recall, wordlist recognition and Trails B). Both treatments significantly reduced ambulatory BP. However, the telmisartan/HCTZ combination produced a greater reduction in 24-h, day-time and night time ABPM values. Lisinopril/ HCTZ did not induce significant changes in any of the cognitive function test scores at any time of the study, whereas at both 12 and 24 weeks telmisartan/HCTZ significantly improved the word-list memory score ( þ 17.1 and þ 15.7%, respectively, Po0.05 vs baseline), the word-list recall score ( þ 13.5 and þ 16.9%, Po0.05) and the Trails B score (À33 and À30.5%, Po0.05). These results suggest that in elderly hypertensive patients treatment with telmisartan/HCTZ produces a slightly greater reduction in ambulatory BP than lisinopril/HCTZ combination and, unlike this latter, improves some of the components of cognitive function, particularly episodic memory and visuospatial abilities.

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Midlife blood pressure and dementia: the Honolulu–Asia aging study☆

Cited by 856 publications

References 35 publications

Influence of losartan and atenolol on memory function in very elderly hypertensive patients

Influence of losartan and atenolol on memory function in very elderly hypertensive patients

The impact of blood pressure on hippocampal glutamate and mnestic function

Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients

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