Low blood pressure and dementia in elderly people: the Kungsholmen project

Guo, Zhenchao; Viitanen, Matti; Fratiglioni, Laura; Winblad, Bengt

doi:10.1136/bmj.312.7034.805

Cited by 262 publications

(185 citation statements)

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“…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. 14,15 Reasons for discrepancies between longitudinal and cross-sectional studies may include the tendency for BP levels to change with the onset of dementia, 7,13 the inclusion of individuals with known cerebrovascular disease in cross-sectional studies and the effects of BP lowering therapy on cognitive function.…”

Section: Introductionmentioning

confidence: 99%

“…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. 14,15 Reasons for discrepancies between longitudinal and cross-sectional studies may include the tendency for BP levels to change with the onset of dementia, 7,13 the inclusion of individuals with known cerebrovascular disease in cross-sectional studies and the effects of BP lowering therapy on cognitive function. In this regard, little consensus exists in the literature about the influence of antihypertensive drugs on the association between hypertension and cognitive performance, with some studies showing better performance on cognitive function tests in treated as compared to untreated hypertensives, 4,5,[16][17][18][19] some studies showing poorer performance 20,21 and other studies showing no difference.…”

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: Introductionmentioning

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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“…Es handelt sich um eine Querschnittsanalyse von .642 Personen in einem mittleren Alter von 82,3 Jahren [26,69]; 2,3% der Studienteilnehmer litten an einer Demenz, die entsprechend DSM-III-R diagnostiziert wurde und nach Clinical Dementia Rating Scale/CDRS [35] in 5 Schweregrade eingeteilt wurde. Sämtlichen Studienteilnehmern wurde -malig BD gemessen.…”

Section: Kungsholmen Project (1996 2003)unclassified

“…An der HO-PE-Studie ist u. a. die Art der Präsentati-on der Ergebnisse bemängelt worden, wodurch die klinischen Effekte überschätzt [84]. In einem Teil der Studien wurden nur -bis 2-malige BD-Messungen durchgeführt [26,36,43,60,69], was sowohl für die Diagnose einer AH als auch als Datengrundlage als unzulänglich gelten kann. Viele Studien verfügen über eine relativ kurze Verlaufsbeobachtung, die für die Interventionsstudien maximal 4,5 Jahre beträgt.…”

Section: Kritische Beurteilung Der Studienergebnisseunclassified

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Arterielle Hypertonie und Demenz

Scheid

Voigt

2005

Nervenarzt

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Die arterielle Hypertonie ist unabhän-gig von ihrer Genese als wichtigster beeinflussbarer Risikofaktor für den Schlaganfall etabliert. Ätiologisch werden 26-49% aller Schlaganfälle auf eine arterielle Hypertonie (AH) zurückgeführt [24]. Über die Konstruktion einer einfachen ätiopa-thogenetischen Reihe AH -Schlaganfall -vaskuläre Demenz (VD) ist die AH mit dem Syndrom Demenz verknüpft. Die Demenzinzidenz nach Schlaganfall wird in der Literatur mit 6-33% angegeben [52,59]. Für den Oberbegriff VD ist eine Reihe spezifischerer Unterteilungen vorgenommen worden. Román et al. unterscheiden eine zerebrale Makroangiopathie+Demenz mit Unterkategorien "multi-infarct" und "strategic-infarct dementia" von einer zerebralen Mikroangiopathie+Demenz mit Unterkategorien "subkortikal ischämisch" und "kortikal subkortikal". Weitere Kategorien sind "ischämisch hypoperfusive VD" und "hämorrhagische VD" [7]. Ein aktueller klinisch-pragmatisch orientierter Ansatz schlägt die Unterscheidung von 3 Typen vor: "post-stroke dementia", subkortikale VD und Alzheimer+VD [86]. Als verbindender Überbegriff dient der Terminus "vascular cognitive impairment" [30,59].Aber auch für die häufigere degenerative Demenz, die Alzheimer-Demenz (AD), wird die AH zunehmend als Risikofaktor diskutiert [0, 72, 75, 79]

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Reducing Antihypertensive Medication Use in Nursing Home Patients

Froom

Trilling²

2000

Archives of Family Medicine

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Of the 1.5 million nursing home residents, about 40% are aged 85 years or older, and a similar percentage have hypertension. The rates of incorrect diagnoses from the "white coat" effect and from errors in blood pressure evaluation are as frequent in older persons as in younger persons. The benefits of antihypertensive treatment and the risks of lowering blood pressures in the very old (> or = 85 years) are uncertain. Elderly patients experience adverse effects from drug treatment that are unique to their age group and that complicate management problems associated with polypharmacy and multiple comorbid conditions. Trials to withdraw or lower the dosage of antihypertensive medications have been successful in up to 40% of elderly persons when combined with salt restriction and weight loss, but such studies are lacking in nursing home patients. The management of hypertension should be reevaluated in nursing home patients.

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Low blood pressure and dementia in elderly people: the Kungsholmen project

Cited by 262 publications

References 31 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

Arterielle Hypertonie und Demenz

Reducing Antihypertensive Medication Use in Nursing Home Patients

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